CORRELATION OF NEUTROPHIL-LYMPHOCYTE RATIO (NLR) AND PLATELET-LYMPHOCYTE RATIO (PLR) WITH COMPLICATIONS AND POSTOPERATIVE SURVIVAL IN SURGERY FOR BONE METASTASIS OF THE APPENDICULAR SKELETON / CORRELAÇÃO DO NEUTROPHIL-LYMPHOCYTE RATIO (NLR) E PLATELET-LYMPHOCYTE RATIO (PLR) COM COMPLICAÇÕES E SOBREVIDA PÓS-OPERATÓRIAS NA CIRURGIA PARA METÁSTASE ÓSSEA DO ESQUELETO APENDICULAR

Introduction: Bone metastasis is the most common malignant neoplasm of the skeleton, and surgical decision-making depends on multiple factors, including postoperative complications and life expectancy. The identification of new prognostic factors can assist in decision making. Objective: In long bones metastases, to analyze the incidence of complications and postoperative survival up to 1 year, correlating them with NLR and PLR. Method: Review of 160 medical records of patients who underwent surgery for bone metastasis in the appendicular skeleton. In addition to epidemiological characteristics, NLR and PLR values were determined, correlating them with survival and complications. Result: Women represented 64.5% with a primary breast tumor in 62.6%; the proximal femur was the most affected; median survival was 13.2 months and in 1 year 34.7%. Tumor resection with endoprosthesis was more common. The post-surgical complication rate was 10% and the average time for post-operative complications to occur was 27.9 days (0-140). An association between the neutrophil variable and postoperative complications was found (p=0.04). For every 100 more units of neutrophils there was a 1% increase in the chances of post-surgical complications. Mean NLR and PLR values were, respectively, 5.3 (0.2-30.7) and 199.7 (32.1-676.7). Patients with NLR NLR ≥ 2 (p<0,001) showed a decrease in survival from 92,3% to 62,5% at the 3rd month, and from 61,5% to 31,3% at 1 year. Those with PLR ≥209 (p<0.001) showed a decrease in survival from 69% to 59.3% at the 3rd month, and from 40.2% to 25.9% at 1 year. Conclusion: There was no positive association between NLR and PLR with postoperative complications, but strongly yes with survival from the 3rd month after surgery.

Introdução: Metástase óssea é a neoplasia maligna mais comum do esqueleto, e a tomada de decisão cirúrgica depende de múltiplos fatores, incluindo as complicações pós-operatórias e a expectativa de vida. A identificação de novos fatores prognósticos pode auxiliar na tomada de decisão. Objetivo: Analisar em metástases de ossos longos, a incidência de complicações e sobrevida pós-operatórias até 1 ano correlacionando-as com NLR e PLR. Método: Revisão de 160 prontuários de operados por metástase óssea no esqueleto apendicular. Além de características epidemiológicas, foram determinados os valores de NLR e PLR correlacionando-os com sobrevida e complicações. Resultado: Mulheres representaram 64,5% com tumor primário na mama em 62,6%; o fêmur proximal foi o mais acometido; sobrevida média foi 13,2 meses e a de 1 ano 34,7%; ressecção tumoral com endoprótese foi mais comum. A taxa de complicação pós-cirúrgicas foi de 10% e o tempo médio para a ocorrência de complicações pós-operatórias foi de 27,9 dias (0-140). Foi encontrada associação da variável neutrófilos com a complicação pós-operatória (p=0,04). A cada 100 unidades a mais de neutrófilos houve aumento de 1% nas chances de complicações pós-cirúrgicas. Valores médios do NLR e PLR foram, respectivamente, 5,3 (0,2-30,7) e 199,7 (32,1-676,7).  Os pacientes com NLR ≥ 2 (p<0,001) apresentaram diminuição na sobrevida de 92,3% para 62,5% no 3° mês e de 61,5% para 31,3% em 1 ano. Aqueles com PLR ≥209 (p<0,001) apresentaram diminuição na sobrevida de 69% para 59,3% no 3° mês, e de 40,2% para 25,9% em 1 ano. Conclusão: Não foi verificada associação positiva entre o NLR e o PLR com complicações pós-operatórias, mas com sobrevida fortemente sim, a partir do 3° mês de pós-operatório.

Lymphopenia predicts 30-day morbidity and mortality following spinal metastasis surgery.

BACKGROUND: Therapeutic decision-making regarding surgical treatment of spinal metastasis is supported by clinical characteristics that are potentially predictive of postoperative events. The predictive power of total lymphocyte count (TLC) in peripheral blood has not been elucidated for this type of surgery. Therefore, the aim of this study was to assess the capacity of TLC to predict 30-day morbidity and mortality following surgery for spinal metastases. METHODS: This is a level III prognostic study, which consists of a retrospective review of records from a cancer referral hospital. Consecutive patients who underwent open surgery for spinal metastatic disease were studied. Outcomes of interest were 30-day post-op mortality and complications. The patients were divided into three groups based on preoperative TLC: low, moderate, and high risk for surgery, according to a discriminatory power analysis. The predictive power of TLC was compared to that of other known predictors, i.e., older age, tumor aggressiveness, and presence of comorbidities. Odds ratios (ORs) and 95% confidence intervals were calculated using bivariate and multivariate analyses. RESULTS: In total, 205 patients underwent surgery. Thirty-day mortality and occurrence of complications were 17% and 31%, respectively. The discriminatory power of TLC was 71% and 68% for 30-day survival and complications, respectively. In multivariate analysis, the strongest relationship between predictors and postoperative morbidity and mortality concerned TLC < 800 cells/µL, which was associated with decreased likelihood of 30-day survival (OR 3.17) and increased likelihood of complications (OR 3.93). Incidence of 30-day mortality and complications by risk group was, respectively: 4% and 13% for low risk (TLC > 1857 cells/µL); 22% and 34% for moderate risk (TLC 800-1857 cells/µL); and 35% and 56% for high risk (TLC < 800 cells/µL). CONCLUSIONS: TLC is a strong predictor of 30-day morbidity and mortality following spinal metastasis surgery. It may be useful for improving patient care and planning personalized treatments.

Spinal Metastasis Surgery: A Proposal for a Predictive Model of Morbidity and Mortality.

Objective To develop a predictive model of early postoperative morbidity and mortality with the purpose of assisting in the selection of the candidates for spinal metastasis surgery. Methods A retrospective analysis of consecutive patients operated for metastatic spinal disease. The possible prognostic preoperative characteristics were gender, age, comorbidities, tumor growth rate, and leukocyte and lymphocyte count in the peripheral blood. The postoperative outcomes were 30-day mortality, 90-day mortality and presence of complications. A predictive model was developed based on factors independently associated with these three outcomes. The final model was then tested for the tendency to predict adverse events, discrimination capacity and calibration. Results A total of 205 patients were surgically treated between 2002 and 2015. The rates of the 30-day mortality, 90-day mortality and presence of complications were of 17%, 42% and 31% respectively. The factors independently associated with these three outcomes, which constituted the predictive model, were presence of comorbidities, no slow-growing primary tumor, and lymphocyte count below 1,000 cells/µL. Exposure to none, one, two or three factors was the criterion for the definition of the following categories of the predictive model: low, moderate, high and extreme risk respectively. Comparing the risk categories, there was a progressive increase in the occurrence of outcomes, following a linear trend. The discrimination capacity was of 72%, 73% and 70% for 30-day mortality, 90-day mortality and complications respectively. No lack of calibration occurred. Conclusion The predictive model estimates morbidity and mortality after spinal metastasis surgery and hierarchizes risks as low, moderate, high and extreme.

ASSESSING PSYCHOSOCIAL DISTRESS IN BONE METASTASES TREATED WITH ENDOPROSTHESIS.

OBJECTIVE: To compare preoperative and early postoperative levels of psychosocial distress in patients undergoing bone metastasis treatment with endoprosthesis, evaluating its impact on quality of life. METHODS: Thirteen patients undergoing endoprosthetic treatment of bone metastasis were assessed at two time points: preoperatively and 30 days postoperatively. The tool used was the Distress Thermometer, a questionnaire for psychosocial screening developed by the National Comprehensive Cancer Network. Distress is considered moderate or severe if the patient scores 4 or higher. RESULTS: The most frequent problems in the preoperative period were "bathing and dressing". At 30 days, "fatigue" and "nervousness" prevailed. There was a significant improvement in distress when preoperative and 30-day assessments were compared. CONCLUSION: The surgical treatment of bone metastasis with endoprosthesis results in an early improvement of psychosocial distress as measured by the Distress Thermometer. Level of evidence II, Prospective and comparative therapeutic study.

OBJETIVO: Confrontar o nível de angústia psicossocial (distress) entre o pré-operatório e o pós-operatório precoce de pacientes submetidos ao tratamento de metástase óssea com endoprótese, avaliando seu impacto na qualidade de vida. MÉTODOS: Foram avaliados 13 pacientes submetidos ao tratamento de metástase óssea com endoprótese em dois momentos: pré-operatório e pós-operatório de 30 dias. A ferramenta utilizada foi o termômetro de Distress, questionário de triagem psicossocial desenvolvido pela National Comprehensive Cancer Network. É considerado distress moderado ou grave se o paciente somar 4 ou mais pontos. RESULTADOS: No pré-operatório, os problemas mais frequentes foram "tomar banho e vestir-se". Com 30 dias, os itens mais prevalentes foram "cansaço" e "nervosismo". Houve melhora significativa do distress quando foram comparadas as avaliações pré-operatória e após 30 dias. CONCLUSÃO: O tratamento cirúrgico com endoprótese para metástase óssea reduz precocemente o nível de angústia psicossocial aferido pelo termômetro de Distress. Nível de evidência II, Estudo terapêutico, prospectivo e comparativo.

Spinal Metastasis Surgery: A Proposal for a Predictive Model of Morbidity and Mortality / Cirurgia em metástase vertebral: Proposta de modelo preditivo de morbimortalidade

Abstract Objective To develop a predictive model of early postoperative morbidity and mortality with the purpose of assisting in the selection of the candidates for spinal metastasis surgery. Methods A retrospective analysis of consecutive patients operated for metastatic spinal disease. The possible prognostic preoperative characteristics were gender, age, comorbidities, tumor growth rate, and leukocyte and lymphocyte count in the peripheral blood. The postoperative outcomes were 30-day mortality, 90-day mortality and presence of complications. A predictive model was developed based on factors independently associated with these three outcomes. The final model was then tested for the tendency to predict adverse events, discrimination capacity and calibration. Results A total of 205 patients were surgically treated between 2002 and 2015. The rates of the 30-day mortality, 90-day mortality and presence of complications were of 17%, 42% and 31% respectively. The factors independently associated with these three outcomes, which constituted the predictive model, were presence of comorbidities, no slow-growing primary tumor, and lymphocyte count below 1,000 cells/µL. Exposure to none, one, two or three factors was the criterion for the definition of the following categories of the predictive model: low, moderate, high and extreme risk respectively. Comparing the risk categories, there was a progressive increase in the occurrence of outcomes, following a linear trend. The discrimination capacity was of 72%, 73% and 70% for 30-day mortality, 90-day mortality and complications respectively. No lack of calibration occurred. Conclusion The predictive model estimates morbidity and mortality after spinal metastasis surgery and hierarchizes risks as low, moderate, high and extreme.

Resumo Objetivo Desenvolver um modelo preditivo de morbimortalidade pós-operatória precoce com o intuito de auxiliar na seleção dos candidatos à cirurgia para metástase vertebral. Métodos Análise retrospectiva de pacientes consecutivos operados por doença metastática vertebral. As características pré-operatórias consideradas possivelmente prognósticas foram: sexo, idade, comorbidades, velocidade de progressão tumoral e contagem de leucócitos e linfócitos no sangue periférico. Os desfechos pós-operatórios analisados foram: mortalidade em 30 dias e em 90 dias, e presença de complicações. Um modelo preditivo foi desenvolvido a partir de fatores independentemente associados a esses três desfechos. Testou-se então o modelo estabelecido quanto à tendência de prever eventos adversos, à capacidade de discriminação e à calibração. Resultados Um total de 205 pacientes foram operados entre 2002 e 2015. A mortalidade em 30 dias e em 90 dias e a incidência de complicações foram de 17%, 42% e 31%, respectivamente. Os fatores independentemente associados a esses três desfechos, e que constituíram o modelo preditivo, foram: presença de comorbidades, tumor primário de progressão não lenta, e linfócitos abaixo de 1.000 células/µL. A exposição a nenhum, um, dois ou três fatores definiu as categorias do modelo preditivo: baixo, moderado, alto e de extremo risco, respectivamente. Comparando-se as categorias, houve aumento progressivo na ocorrência dos desfechos, seguindo tendência linear. A capacidade de discriminação foi de 72%, 73% e 70% para mortalidade em 30 dias, em 90 dias e incidência de complicações, respectivamente. Não ocorreu falta de calibração. Conclusão O modelo preditivo permite estimar a morbimortalidade após a cirurgia para metástase vertebral e hierarquizar os riscos em baixo, moderado, alto e extremo.

Assessing psychosocial distress in bone metastases treated with endoprosthesis / Avaliação da angústia psicossocial na metástase óssea tratada com endoprótese

ABSTRACT Objective: To compare preoperative and early postoperative levels of psychosocial distress in patients undergoing bone metastasis treatment with endoprosthesis, evaluating its impact on quality of life. Methods: Thirteen patients undergoing endoprosthetic treatment of bone metastasis were assessed at two time points: preoperatively and 30 days postoperatively. The tool used was the Distress Thermometer, a questionnaire for psychosocial screening developed by the National Comprehensive Cancer Network. Distress is considered moderate or severe if the patient scores 4 or higher. Results: The most frequent problems in the preoperative period were "bathing and dressing". At 30 days, "fatigue" and "nervousness" prevailed. There was a significant improvement in distress when preoperative and 30-day assessments were compared. Conclusion: The surgical treatment of bone metastasis with endoprosthesis results in an early improvement of psychosocial distress as measured by the Distress Thermometer. Level of evidence II, Prospective and comparative therapeutic study.

RESUMO Objetivo: Confrontar o nível de angústia psicossocial (distress) entre o pré-operatório e o pós-operatório precoce de pacientes submetidos ao tratamento de metástase óssea com endoprótese, avaliando seu impacto na qualidade de vida. Métodos: Foram avaliados 13 pacientes submetidos ao tratamento de metástase óssea com endoprótese em dois momentos: pré-operatório e pós-operatório de 30 dias. A ferramenta utilizada foi o termômetro de Distress, questionário de triagem psicossocial desenvolvido pela National Comprehensive Cancer Network. É considerado distress moderado ou grave se o paciente somar 4 ou mais pontos. Resultados: No pré-operatório, os problemas mais frequentes foram "tomar banho e vestir-se". Com 30 dias, os itens mais prevalentes foram "cansaço" e "nervosismo". Houve melhora significativa do distress quando foram comparadas as avaliações pré-operatória e após 30 dias. Conclusão: O tratamento cirúrgico com endoprótese para metástase óssea reduz precocemente o nível de angústia psicossocial aferido pelo termômetro de Distress. Nível de evidência II, Estudo terapêutico, prospectivo e comparativo.

Reconstrução após ressecção extensa de tumor das cinturas pélvica e escapular: relato de dois casos / Reconstruction following extensive tumor resection of the pelvic and scapular girdle: a report of two cases

As cirurgias radicais para tratamento dos tumores da cintura pélvica e escapular (hemipelvectomias e desarticulações interescapulotorácicas) constituem-se, em geral, em procedimentos extensos com grandes áreas de perda de substância local após ressecção do tumor. A utilização do retalho que inclui toda a musculatura anterior e posterior da coxa após dissecção do fêmur, pediculado pelos vasos femorais superficiais, foi descrita apenas uma vez na literatura. O retalho similar utilizando toda a musculatura anterior e posterior do braço após dissecção do úmero, pediculado pelos vasos subclávios para reconstrução após desarticulação interescapulotorácica, não apresenta relatos. Descrevemos dois casos - um de hemipelvectomia e outro de desarticulação interescapulotorácica - utilizando estes dois retalhos para fechamento do defeito.

Radical surgeries for treatment of scapular and pelvic girdle tumors (hemipelvectomy and interscapulothoracic amputation) are generally extended procedures, with large areas of local tissue loss after tumor resection. The use of a flap that includes all the anterior and posterior thigh musculature after femur dissection, pedicled in the superficial femoral vessels, has been described was only once in the medical literature, and there have been no reports on a similar flap using the whole anterior and posterior musculature of the arm after humerus dissection, pedicled in the subclavian vessels, for reconstruction after interscapulothoracic amputation. Here, we describe two cases - one hemipelvectomy and one interscapulothoracicl amputation - using these two the flaps to close the defect.

RECONSTRUCTION FOLLOWING EXTENSIVE TUMOR RESECTION OF THE PELVIC AND SCAPULAR GIRDLE: A REPORT OF TWO CASES.

Radical surgeries for treatment of scapular and pelvic girdle tumors (hemipelvectomy and interscapulothoracic amputation) are generally extended procedures, with large areas of local tissue loss after tumor resection. The use of a flap that includes all the anterior and posterior thigh musculature after femur dissection, pedicled in the superficial femoral vessels, has been described was only once in the medical literature, and there have been no reports on a similar flap using the whole anterior and posterior musculature of the arm after humerus dissection, pedicled in the subclavian vessels, for reconstruction after interscapulothoracic amputation. Here, we describe two cases - one hemipelvectomy and one interscapulothoracicl amputation - using these two the flaps to close the defect.

STUDY ON THE APPLICABILITY OF THE MODIFIED TOKUHASHI SCORE IN PATIENTS WITH SURGICALLY TREATED VERTEBRAL METASTASIS.

UNLABELLED: To present the results obtained from surgical treatment of patients with vertebral metastases, comparing them with the modified Tokuhashi score in order to validate the applicability of this score for prognostic predictions and for choosing surgical treatments. METHODS: This was a retrospective study on 157 patients treated surgically for spinal metastasis in Erastus Gaertner Hospital in Curitiba. The Tokuhashi score was applied retrospectively to all the patients. The patients' actual survival time was compared with the expected survival time using the Tokuhashi score. RESULTS: There were 82 females and 75 males. The most frequent location of the primary tumor was the breast. The thoracic region was involved in 66.2%, lumbar region in 65.6%, cervical region in 15.9% and sacral region in 12.7%. All the patients underwent surgical treatment. The most frequent indication for treatment was intractable pain (89.2%). There was partial or complete improvement in a majority of the cases (52.2%). Out of 157 cases studied, 86.6% died. The maximum survival time was 13.6 years, the minimum was 3 days and the mean was 13.2 months. The following frequencies of Tokuhashi scores were found among the operated cases: up to 8 points, 111 cases; 9-11 points, 43 cases; and 12-15 points, three cases. The mean survival time in months for all 157 patients according to the Tokuhashi score was: 0-8 points, 15.4 months; 9-11 points, 11.4 months; and 12-15 points, 12 months. CONCLUSION: Unlike the nonsurgical approach recommended by Tokuhashi for patients with lower scores, this group in our study was sent for surgery, with better results than those of non-operated patients reported by Tokuhashi.

Estudo da aplicabilidade do escore de Tokuhashi modificado nos pacientes tratados cirurgicamente de metástases vertebrais / Study on the applicability of the modified Tokuhashi score in patients with surgically treated vertebral metastasis

OBJETIVO: Apresentar os resultados obtidos no tratamento dos pacientes com metástases vertebrais, tratados cirurgicamente, comparando-os com o escore de Tokuhashi modificado, a fim de validar a aplicabilidade deste escore na predição prognóstica e na escolha terapêutica cirúrgica. MÉTODOS: Estudo retrospectivo de 157 pacientes tratados cirurgicamente por metástase vertebral no Hospital Erasto Gaertner em Curitiba. O escore de Tokuhashi foi aplicado, retrospectivamente, em todos os pacientes. O tempo de sobrevida real dos pacientes foi comparado com o tempo de sobrevida esperado pelo escore de Tokuhashi. RESULTADOS: Foram estudados 82 pacientes do sexo feminino e 75 do masculino. O local do tumor primário mais frequente foi a mama. A região torácica foi acometida em 66,2 por cento, lombar em 65,6 por cento, cervical em 15,9 por cento e sacral em 12,7 por cento. Todos os pacientes foram submetidos ao tratamento cirúrgico. A indicação mais frequente do tratamento foi dor intratável (89,2 por cento). Houve melhora parcial ou total na maioria dos casos (52,2 por cento). Dos 157 casos estudados, 86,6 por cento evoluíram a óbito, sendo o tempo máximo de sobrevida de 13,6 anos, o mínimo de três dias e o médio de 13,2 meses. A pontuação dos casos operados segundo Tokuhashi apresentou a seguinte frequência: até 8 pontos, 111 casos; de 9 a 11 pontos, 43 casos e de 12 a 15 pontos, três casos. O tempo médio de sobrevida em meses para todos os 157 pacientes segundo o escore de Tokuhashi foi: de 0 a 8 pontos, 15,4 meses; de 9 a 11 pontos, 11,4 meses; e de 12 a 15 pontos, 12 meses. CONCLUSÃO: Diferente da conduta não cirúrgica preconizada por Tokuhashi para os pacientes de pontuação mais baixa, em nosso estudo, este mesmo grupo foi encaminhado à cirurgia com resultados melhores do que os pacientes não operados referidos por Tokuhashi.

OBJECTIVE: To present the results obtained from surgical treatment of patients with vertebral metastases, comparing them with the modified Tokuhashi score in order to validate the applicability of this score for prognostic predictions and for choosing surgical treatments. METHODS: This was a retrospective study on 157 patients treated surgically for spinal metastasis in Erastus Gaertner Hospital in Curitiba. The Tokuhashi score was applied retrospectively to all the patients. The patients' actual survival time was compared with the expected survival time using the Tokuhashi score. RESULTS: There were 82 females and 75 males. The most frequent location of the primary tumor was the breast. The thoracic region was involved in 66.2 percent, lumbar region in 65.6 percent, cervical region in 15.9 percent and sacral region in 12.7 percent. All the patients underwent surgical treatment. The most frequent indication for treatment was intractable pain (89.2 percent). There was partial or complete improvement in a majority of the cases (52.2 percent). Out of 157 cases studied, 86.6 percent died. The maximum survival time was 13.6 years, the minimum was 3 days and the mean was 13.2 months. The following frequencies of Tokuhashi scores were found among the operated cases: up to 8 points, 111 cases; 9-11 points, 43 cases; and 12-15 points, three cases. The mean survival time in months for all 157 patients according to the Tokuhashi score was: 0-8 points, 15.4 months; 9-11 points, 11.4 months; and 12-15 points, 12 months. CONCLUSION: Unlike the nonsurgical approach recommended by Tokuhashi for patients with lower scores, this group in our study was sent for surgery, with better results than those of non-operated patients reported by Tokuhashi.

HEMIPELVECTOMY: ERASTO GAERTNER HOSPITAL'S EXPERIENCES WITH 32 CASES IN 10 YEARS.

OBJECTIVE: To show the experience of the Erasto Gaertner Hospital with hemipelvectomy surgery over a 10-year period. METHODS: This was a retrospective study on 32 patients who underwent hemipelvectomy at Erasto Gaertner Hospital between 1998 and 2008, assessing clinical and surgical characteristics. RESULTS: Among the 32 patients, 15 were female and 17 were male. The mean age was 37.94 years. Eight cases showed involvement of the neurovascular bundle: three were located in the iliac and extended to the thigh, two were in the acetabulum and extended to the thigh and three were in the acetabulum and pubis. Twenty-three cases presented a neurovascular bundle free from neoplasia: 11 were restricted to the iliac, six were in the acetabular region, two were in the pubic ramus and four extended to the whole hemipelvis bone. One case involved the iliac-femoral vessels: one in the pubic ramus. Seven cases of chondrosarcoma and four cases of Ewing's sarcoma represented the majority. Eight cases underwent external hemipelvectomy and 24 underwent internal hemipelvectomy (11 were type I; four were type II; two were type II + III; three were type III and four were type IV). Of these 24 cases, 13 did not have any reconstruction, 10 had a fibular graft and one had an iliacfemoral vein and artery prosthesis. Twenty-six surgeries were curative and six were palliative. There were 14 deaths. Survival of two and five years was seen in 11 and 10 cases, respectively. For six cases, less than two years had passed since the operation. Three cases were lost during follow-up. CONCLUSION: This study shows the experiences of an oncology reference service specializing in highly complex surgical treatment.

Hemipelvectomia: experiência do Hospital Erasto Gaertner com 32 casos em 10 anos / Hemipelvectomy: Erasto Gaertner Hospital's experiences with 32 cases in 10 years

OBJETIVO: Mostrar a experiência do Hospital Erasto Gaertner com as cirurgias de hemipelvectomias em um período de 10 anos. MÉTODOS: Estudo retrospectivo de 32 pacientes submetidos à hemipelvectomia de 1998 a 2008, avaliando características clínico-cirúrgicas. RESULTADOS: Dos 32 pacientes, 15 eram do sexo feminino e 17 do masculino. A média de idade foi de 37,94 anos. Oito casos apresentavam comprometimento de feixe vasculonervoso: três localizavam-se em ilíaco com extensão para a coxa, dois em acetábulo com extensão para coxa e três em acetábulo e púbis. Vinte e três apresentavam o feixe vasculonervoso livre de neoplasia: 11 restritos ao ilíaco, seis em região acetabular, dois em ramo púbico, quatro com extensão a toda hemipelve óssea. Um apresentava comprometimento de vasos ilíacos-femorais: um em ramo púbico. Sete casos de condrossarcoma e quatro de sarcoma de Ewing, representaram a maioria. Oito foram submetidos à hemipelvectomia externa e 24 à hemipelvectomia interna (11 tipo I, quatro tipo II, dois tipo II + III, três tipo III e quatro tipo IV). Destes 24 casos, 13 sem reconstrução, 10 com enxerto de fíbula e um com prótese de veia e artéria ilíaco-femorais. Vinte e seis cirurgias foram curativas e seis paliativas. Houve 14 óbitos. Sobrevida de dois e cinco anos observada em 11 e 10 casos, respectivamente. Seis casos apresentam menos de dois anos de cirurgia. Em três casos houve perda de acompanhamento. CONCLUSÃO: Os dados mostram a experiência de um serviço de referência em oncologia, especializado no tratamento de cirurgias de alta complexidade.

OBJETIVE: To review the experience of the Erasto Gaertner Hospital with hemipelvectomies of surgeries over a period of 10 years. METHODS: A retrospective study of 32 patients who underwent hemipelvectomy in Erasto Gaertner Hospital from 1998 to 2008, assessing clinical and surgical characteristics. RESULTS: Of 32 patients, 15 were female and 17 male. The mean age was 37.94 years. Eight cases showed involvement of the neurovascular bundle: 3 were located in the iliac and extended to the thigh, 2 were in the acetabulum and extended to the thigh and 3 were in the acetabulum and pubis. One involved the iliac-femoral vessels: one in the pubic ramus. Seven cases of chondrosarcoma and 4 cases of Ewing's sarcoma represented the majority. Eight underwent external hemipelvectomy and 24 underwent internal hemipelvectomy (11 were type I; 4 were type II; 2 were type II + III; 3 were type III and 4 were type IV). Of these 24 cases, 13 were without reconstruction, 10 were with a fibular graft and 1 was with an iliac-femoral vein and artery prosthesis. Twenty-six surgeries were curative and 6 palliative. There were 14 deaths. Survival of 2 and 5 years were seen in 11 and 10 cases, respectively. Six cases have less than 2 years of surgery. Three cases were lost during follow-up. CONCLUSION: The study shows the experiences of an exemplary oncology service, specializing in highly complex surgical treatment.