Finding the least disruptive solution to get patients back on their feet

Home to 1,700 people, its claim to fame, according to the Tangipahoa Parish tourist information center, is the annual Sicilian Heritage Festival — complete with meatball-throwing contest — a nod to the town’s Italian immigrant roots. It was originally known as Uncle Sam.

It seems especially meaningful that one of its residents, Cathy Helminiak, has gained her “independence” as a survivor of pelvic sarcoma, a form of cancer in the bone and soft tissue of the hip. She can be seen with or without her prosthetic leg, in or out of her wheelchair, busily tending to her garden, fishing from her boat or joyfully visiting with her grandchildren.

As a cancer survivor treated at MD Anderson, she’s something of a town crier as well, always up for talking with a new patient who has the same fears she faced only four years ago. Her husband, David, knows only too well the path she’s traveled.

“She stood up hours after surgery and it was one of the most beautiful things I’d ever seen,” he says.

Helminiak is one of the many MD Anderson pelvic sarcoma patients who have undergone a procedure known as a hemipelvectomy, which involves surgically removing part of the pelvis, with or without removal of the corresponding leg. A multidisciplinary team of surgeons, led by Valerae Lewis, M.D., chair ad interim of Orthopedic Oncology, performs the procedure.

The ‘cans’ and ‘shoulds’ of pelvic cancer surgery

Though pelvic cancer is rare, Lewis and her team perform 35 to 50 hemipelvectomies each year. Surgeries vary depending on the location and size of the tumor.

In some patients, the entire half of the pelvis and leg are removed. In others, one or more of the pelvic bone’s three sections are removed.

Some patients opt to have their pelvic bone reconstructed after surgery.

“The patient’s own bone, a cadaver bone or a prosthesis can be used to reconstruct the pelvis,” Lewis says. “The decision whether to perform reconstructive surgery is made by patients in consultation with their families and physicians.”

Experts from many disciplines participate in the care of hemipelvectomy patients, Lewis says.

“This is absolutely vital as pelvic tumors can affect any of the organs in the pelvic region, such as the kidneys, bladder, intestine, prostate or vagina, and can impact muscles, bones, nerves and arteries.”

Lewis prefers to offer the least disruptive solution, which involves removing the tumor while saving as much normal bone as possible. Beyond this strategy, Lewis believes it’s not a question of “Can we?,” but rather “Should we?”. It’s a question that can determine a patient’s level of post-surgery mobility.

Surgery for pelvic tumors involves either external hemipelvectomies (amputation of the whole leg plus part of the pelvis on one side) or internal (removal of the pelvis on one side without leg amputation). Patients who have internal hemipelvectomies may have reconstruction of the surgically removed portions of their pelvis.

The pelvis contains three main sections: the ilium (upper portion), the ischium (lower portion) and, sandwiched in between, the hip joint. If the tumor must be removed from two of the main sections, it’s unlikely the leg can maintain good function, and amputation is recommended.

Regardless of the type of surgery, Lewis is always asked the same question: “When will I be able to start walking again?”

While the recovery and mobility vary with each patient, Lewis says most are back to their activities within six months to a year.

“Patients who’ve had their hemipelvis removed, with or without the leg, can often return to their daily activities with the help of aggressive physical therapy,” says Lewis.

“Our job isn’t over when patients leave the OR,” adds Lewis. “It’s over when they’re walking again and back to their normal life activities.”