Oncologic outcomes of surgically managed primary pelvic soft tissue sarcoma; tumour biology or surgical constraints of the true pelvis?

Published:December 16, 2022DOI:



      Pelvic soft tissue sarcomas are rare. Potentially curative resection remains challenging due to anatomical constraints of true pelvis and tumour spread through various anatomical hiatus. We sought to review the oncological outcomes of surgically managed cases at our centre and determine whether outcomes differ for patients with localised (limited to pelvis) versus extensive disease (with extra-pelvic extension).


      Sixty-seven patients who underwent surgical resection with curative intent at the centre for primary, non-metastatic, WHO intermediate to high-grade soft tissue sarcoma of the true pelvis from January 2012 through January 2020 were analysed. Establishment of the extent of disease was made by review of pre-treatment imaging and surgical notes. Oncologic endpoints examined were resection margin, recurrence rate, disease-free and overall survival.


      Rates of complete oncological resection and disease control were similar for tumours with localised or extensive disease. On logistic regression analysis, tumour grade, and a negative resection margin (R0) correlated with the risk of recurrence (p=<0.05). On further multinomial analysis, R0 resection was associated with improved local control, but not metastatic relapse (p = 0.003).
      5-year local recurrence-free and distant metastasis-free survival were 61.3% and 67.1%, respectively. Five and 10-year overall survival were 64% and 36%, respectively. Age >50 years and high tumour grade were associated with a worse outcome (p < 0.05).


      When potentially curative surgery is performed for pelvic sarcoma, disease-extent does not influence oncologic outcomes. While a complete oncologic resection determines the risk of local recurrence, tumour grade and metastatic relapse remain primary prognostic determinants for overall survival.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Levy A.D.
        • Manning M.A.
        • Al-Refaie W.B.
        • Miettinen M.M.
        Soft-tissue sarcomas of the abdomen and pelvis: radiologic-pathologic features, Part 1-common sarcomas: from the radiologic pathology archives.
        Radiographics. 2017; 37: 462-483
        • Keyzer-Dekker C.M.
        • Houtkamp R.G.
        • Peterse J.L.
        • Van Coevorden F.
        Adult pelvic sarcomas: a heterogeneous collection of sarcomas?.
        Sarcoma. 2004; 8: 19-24
        • Nakamura T.
        • Abudu A.
        • Murata H.
        • et al.
        Oncological outcome of patients with deeply located soft tissue sarcoma of the pelvis: a follow up study at minimum 5 years after diagnosis.
        Eur J Surg Oncol. 2013; 39: 1030-1035
        • Wanebo H.J.
        Pelvic soft tissue sarcomas present a challenge to therapists.
        J Surg Oncol. 2001; 77: 79-80
        • Mullen J.T.
        • van Houdt W.
        Soft tissue tumors of the pelvis: technical and histological considerations.
        J Surg Oncol. 2018; 117: 48-55
        • Tan M.C.
        • Yoon S.S.
        Surgical management of retroperitoneal and pelvic sarcomas.
        J Surg Oncol. 2015; 111: 553-561
        • Lewis S.J.
        • Wunder J.S.
        • Couture J.
        • et al.
        Soft tissue sarcomas involving the pelvis.
        J Surg Oncol. 2001; 77: 8-15
        • Murata H.
        • Kalra S.
        • Ahrens H.
        • Abudu A.
        • Grimer R.J.
        • Carter S.R.
        • et al.
        Soft tissue sarcomas of the pelvis.
        Orthopaedic Proceedings. 2008; 90-B (401-401)
        • Pozniak M.
        • Petasnick J.P.
        • Matalon T.A.S.
        • Bayard W.J.
        Computed tomography in the differential diagnosis of pelvic and extrapelvic disease.
        Radiographics. 1985; 5: 587-610
        • Sugawara S.
        • Ehara S.
        • Hitachi S.
        • Okada K.
        Patterns of soft-tissue tumor extension in and out of the pelvis.
        AJR Am J Roentgenol. 2010; 194: 746-753
        • Apffelstaedt J.P.
        • Zhang P.J.
        • Driscoll D.L.
        • Karakousis C.P.
        Various types of hemipelvectomy for soft tissue sarcomas: complications, survival and prognostic factors.
        Surg Oncol. 1995; 4: 217-222
        • Baliski C.R.
        • Schachar N.S.
        • McKinnon J.G.
        • Stuart G.C.
        • Temple W.J.
        Hemipelvectomy: a changing perspective for a rare procedure.
        Can J Surg. 2004; 47: 99-103
        • Carter S.R.
        • Eastwood D.M.
        • Grimer R.J.
        • Sneath R.S.
        Hindquarter amputation for tumours of the musculoskeletal system.
        J Bone Joint Surg Br. 1990; 72: 490-493
        • WHO Classification of Tumours Editorial Board
        Soft tissue and bone tumours.
        International Agency for Research on Cancer, Lyon (France)2020 (WHO classification of tumours series, 5th ed. vol. 3)
        • Wittekind C.
        • Compton C.C.
        • Greene F.L.
        • Sobin L.H.
        TNM residual tumor classification revisited.
        Cancer. 2002 May 1; 94 (PMID: 12015777): 2511-2516
        • Soomers V.L.M.N.
        • Husson O.
        • Desar I.M.E.
        • et al.
        Patient and diagnostic intervals of survivors of sarcoma: results from the SURVSARC study.
        Cancer. 2020; 126: 5283-5292
        • Kong J.C.
        • Peacock O.
        • Waters P.S.
        • et al.
        Predictors of overall survival following extended radical resections for locally advanced and recurrent pelvic malignancies.
        Langenbeck's Arch Surg. 2020; 405: 491-502
        • Lampe B.
        • Luengas-Würzinger V.
        • Weitz J.
        • et al.
        Opportunities and limitations of pelvic exenteration surgery.
        Cancers. 2021; 13 (Published 2021 Dec 7): 6162
        • Mirnezami R.
        • Mirnezami A.
        Multivisceral resection of advanced pelvic tumors: from planning to implementation.
        Clin Colon Rectal Surg. 2020 Sep; 33 (Epub 2020 Sep 18. PMID: 32968362; PMCID: PMC7500962): 268-278
        • PelvEx Collaborative
        Surgical and survival outcomes following pelvic exenteration for locally advanced primary rectal cancer: results from an international collaboration.
        Ann Surg. 2019; 269: 315-321
        • Lau Y.C.
        • Brown K.G.M.
        • Lee P.
        Pelvic exenteration for locally advanced and recurrent rectal cancer-how much more?.
        J Gastrointest Oncol. 2019; 10: 1207-1214
        • Pisters P.W.
        • Leung D.H.
        • Woodruff J.
        • Shi W.
        • Brennan M.F.
        Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities.
        J Clin Oncol. 1996; 14: 1679-1689
        • Smith H.G.
        • Panchalingam D.
        • Hannay J.A.
        • Smith M.J.
        • Thomas J.M.
        • Hayes A.J.
        • et al.
        Outcome following resection of retroperitoneal sarcoma.
        Br J Surg. 2015 Dec; 102 (Epub 2015 Sep 23. PMID: 26395577): 1698-1709
        • Trovik C.S.
        • Bauer H.C.
        • Alvegård T.A.
        • et al.
        Surgical margins, local recurrence and metastasis in soft tissue sarcomas: 559 surgically-treated patients from the Scandinavian Sarcoma Group Register.
        Eur J Cancer. 2000; 36: 710-716
        • Weitz J.
        • Antonescu C.R.
        • Brennan M.F.
        Localized extremity soft tissue sarcoma: improved knowledge with unchanged survival over time.
        J Clin Oncol. 2003; 21: 2719-2725
        • Pacelli F.
        • Tortorelli A.P.
        • Rosa F.
        • et al.
        Retroperitoneal soft tissue sarcoma: prognostic factors and therapeutic approaches.
        Tumori. 2008; 94: 497-504
        • Chiappa A.
        • Zbar A.P.
        • Bertani E.
        • et al.
        Primary and recurrent retroperitoneal soft tissue sarcoma: prognostic factors affecting survival.
        J Surg Oncol. 2006; 93: 456-463
        • Wirbel R.J.
        • Schulte M.
        • Mutschler W.E.
        Surgical treatment of pelvic sarcomas: oncologic and functional outcome.
        Clin Orthop Relat Res. 2001; 390: 190-205
        • Han I.
        • Lee Y.M.
        • Cho H.S.
        • Oh J.H.
        • Lee S.H.
        • Kim H.S.
        Outcome after surgical treatment of pelvic sarcomas.
        Clin Orthop Surg. 2010; 2: 160-166
        • Lee P.J.
        • Meshkat B.
        • Sasidharan P.
        • Zahid A.
        • Coker D.J.
        • Solomon M.J.
        Survival and morbidity outcomes after pelvic exenteration for pelvic sarcoma: an institutional series [published online ahead of print, 2021 Oct 18].
        ANZ J Surg. 2021;
        • Clavien P.A.
        • Sanabria J.R.
        • Strasberg S.M.
        Proposed classification of complications of surgery with examples of utility in cholecystectomy.
        Surgery. 1992; 111 (518-5)


      Multidisciplinary Team
      World Health Organisation
      Eastern Cooperative Oncology Group
      International Business Machines Corporation
      TAH BSO
      Total abdominal hysterectomy and bilateral salpingo-oophorectomy
      Radiation therapy
      Disease free survival
      Distant metastatic relapse free survival
      Retroperitoneal sarcoma
      Gastrointestinal stromal tumour