title: Oncological and surgical outcome after treatment of pelvic sarcomas.
abstract: OBJECTIVE
  Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term oncological and surgical outcome of these patients.
  
  
  METHODS
  Between 1980 and 2012, 147 patients underwent surgical treatment for pelvic sarcoma. Histological diagnosis was Chondrosarcoma in 54, Ewing's Sarcoma/PNET in 37, Osterosarcoma in 32 and others in 24 patients. Statistical analysis for the evaluation of oncological and surgical outcome was performed by applying Cox proportional hazards regression and Fine-Gray regression models for competing risk (CR) endpoints.
  
  
  RESULTS
  The estimated overall survival (OS) to death was 80%, 45% and 37% at 1, 5 and 10 years, respectively. Univariate analyses revealed a statistically significant unadjusted influence of age age (p = 0.038; HR = 1.01), margin (p = 0.043; HR = 0.51) and grade (p = 0.001; HR = 2.27) on OS. Considering the multivariable model, grade (p = 0.005; HR = 3.04) and tumor volume (p = 0.014; HR = 1.18) presented themselves as independent prognostic factors on OS. CR analysis showed a cumulative incidence for major complication of 31% at 5 years. Endoprosthetic reconstruction had a higher risk for experiencing a major complication (p<0.0001) and infection (p = 0.001).
  
  
  CONCLUSIONS
  Pelvic resections are still associated with a high incidence of complications. Patients with pelvic reconstruction and high volume tumors are especially at risk. Consequently, a cautious decision-making process is necessary when indicating pelvic reconstruction, although a restrictive approach to pelvic reconstruction is not necessarily reasonable when the other option is major amputation.
authors.affiliation: Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18-20 Vienna. Austria.
authors.forename: Stephan E
authors.initials: SE
authors.lastname: Puchner
authors.affiliation: Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18-20 Vienna. Austria.
authors.forename: Philipp T
authors.initials: PT
authors.lastname: Funovics
authors.affiliation: Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18-20 Vienna. Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Böhler
authors.affiliation: Center for Medical Statistics, Informatics, and Intelligent Systems-Section for Clinical Biometrics, Medical University of Vienna Waehringer Guertel 18-20 Vienna. Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kaider
authors.affiliation: Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18-20 Vienna. Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Stihsen
authors.affiliation: Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18-20 Vienna. Austria.
authors.forename: Gerhard M
authors.initials: GM
authors.lastname: Hobusch
authors.affiliation: Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18-20 Vienna. Austria.
authors.forename: Joannis
authors.initials: J
authors.lastname: Panotopoulos
authors.affiliation: Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18-20 Vienna. Austria.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Windhager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006428:Hemipelvectomy / Q000009:adverse effects; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010386:Pelvic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D011183:Postoperative Complications; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D012509:Sarcoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult