Anatomical Difficulties of Hemipelvectomy and Sacrectomy from the View of Vascular Complex

Hemipelvectomy and Sacrectomy are infrequently performed and associated with a high rate of postoperative mortality and morbidity [1-5]. The difficulty of these procedures are contributed by a lot of factors including the anatomical complexity, the proximity of important organs and structures including major nerves, viscera, and major vessels, consistency of huge tumor, necessity of intraoperative postural change, pelvic ring reconstruction and high rate of postoperative complications [2,5-7]. The important large arteries in the pelvic cavity consist of the common iliac artery and its downstream arteries. The important downstream branches of those arteries are the superior and inferior gluteal arteries and obturator arteries. The following structures in pelvic cavity should be treated carefully; femoral nerve, sciatic nerve, nerve roots from lumbar vertebrae and sacrum and ureters. They are sometimes hidden by tumor and are easily damaged with surgical procedures. The greater sciatic notch is one of the most careful points during pelvic tumor resection because of anatomical importance and limited visibility.