Urological Intervention During Hemipelvectomy for Advanced Pelvic Malignancy: Experience From a Comprehensive Cancer Center

Objective: To describe the rate and types of urological intervention during hemipelvectomy, performed for locally advanced cancers of the bony pelvis. Methods: A retrospective review was performed of all cases of internal and external hemipelvectomy from January 2011 to July 2020. Data acquisition included primary tumor histology, resection type, neural manipulation or division, primary procedures (at time of hemipelvectomy), secondary (conducted to address urological sequelae after hemipelvectomy), and complications according to the Clavien-Dindo classification system. Pelvic resection type was classified according to the Enneking and Dunham system. Results: In total, 221 cases of hemipelvectomy were performed during the study period, including 149 cases of internal hemipelvectomy and 72 cases of external hemipelvectomy. A total of 18 patients required intraoperative urological intervention at a rate of 8.1% (internal hemipelvectomy: 8.05%, external hemipelvectomy: 8.22%). Urological intervention included a combination of planned and secondary interventions, of which involvement was most frequently required in hemipelvectomies involving type III resections. The most common interventions were bladder, prostate, or urethral mobilization (31%), cystorrhaphy (22%), cystectomy and urinary diversion (13%), and ureteral reimplantation (13%). The most common complications were urinary retention and urinary incontinence, occurring in two patients each. Limitations included retrospective review, small sample sizes, and potential underreporting of complications. Conclusion: The most common areas requiring urological intervention involved mobilization of the ureter, bladder, prostate, and urethra. The intervention rate was in this small series, but equal between internal and external approaches and it is most common with pubic resections.