A pictographic guide for decision making in surgery for pelvic bone sarcoma

Pelvic bone sarcoma surgery is challenging due to complex anatomy, proximity to major neurovascular structures, and, more importantly, the potential for complications. Decision-making is vital in offering patients the best oncological and functional outcomes after surgery. Multidisciplinary teams involved from the stage of diagnosis and treatment planning, followed by surgery by experienced teams have proven to be beneficial. Tumour-free margin clearance is essential, and surgical planning must be tailored to achieve the same. The choice of reconstruction needs to be decided based on the amount of bone resected and the available expertise and resources. Lesions isolated only to PI or PIII region may not need reconstruction. Though pedestal cups and Custom-made prosthesis are useful in reconstruction after periacetabular tumour resections, hip transposition surgery is also widely practiced by surgeons with favourable outcomes particularly after neo-adjuvant radiotherapy/proton beam therapy. Navigation has shown promise in achieving tumour-negative margins and disease-free progression particularly in chondrosarcoma. A flap-based approach can be considered for hindquarter amputations; however, patients need to be counseled regarding the complications following this surgery. This article, with proposed flowcharts, is aimed at providing practicing surgeons with a guide toward decision-making while planning pelvic bone sarcoma surgery.