Surgical treatment of patients with pelvic bone metastases

Introduction. Pelvic bone metastases are a common complication of malignant tumors, leading to pain, pathological fractures, and decreased quality of life. Surgical treatment plays a key role in palliative care, but the optimal approaches remain controversial.
Aim. To evaluate the results of surgical treatment of patients with pelvic bone metastases, including oncologic and functional outcomes, as well as complication rates.
Materials and methods. A retrospective analysis of 39 patients (21 men, 18 women; median age 55 years) who underwent surgical treatment for metastatic pelvic bone lesions in the period 2002–2022 was performed. The most common localizations were the ilium (10 (25.6 %) cases) and sacrum (13 (33.3 %) cases). A solitary lesion was detected in 33 (84.6 %) patients and multiple bone lesions in 6 (5.4 %) patients. The primary lesion in most cases (in 19 (48.7 %) patients) was kidney cancer. Radical (wide resections) (71.8 % cases) and palliative (decompression and excohleations) (23.1 % cases) methods were used. Survival, complications (according to the Clavien–Dindo classification), pain dynamics (according to the visual analog and Watkins scales) and functional status (according to the Karnofsky scale) were assessed.
Results. Complications developed in 28.2 % of patients, mainly after resections involving the acetabulum (p = 0.029). 
The leading complications were deep infections (8 cases), superficial necrosis (3 cases), which required additional surgical interventions. The median overall survival was 45 months, with solitary metastases – 93 months, with multiple metastases – 20 months (p = 0.019). Intralesional resections were associated with worse survival (p = 0.028). A significant decrease in pain (from 5 to 2 according to the visual analog scale; p <0.001) and improvement in functional status (according to the Karnofsky scale; p = 0.022) were noted. 
Conclusion. Radical resections provide better survival in solitary metastases group, while palliative methods are appropriate for multiple lesions. The choice of tactics requires a multidisciplinary approach, taking into account the prognosis and extent of the lesion.

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