Development and External Validation of a Prognostic Staging System for Predicting Wound Complication after Internal Hemipelvectomy: An International Multicenter Study.

Abstract

Internal hemipelvectomy is a challenging procedure often complicated by wound healing issues. To guide surgical planning and reduce the risk of wound complications, we developed and validated a preoperative risk-stratification model. We reviewed clinical, surgical, and pathologic data from 411 patients who underwent en bloc internal hemipelvectomy for malignant pelvic tumors between 1996 and 2018. The sample included a training set (N = 123) from a US tertiary hospital and a validation set (N = 288) from centers in Canada and The Netherlands. Using logistic regression, we identified key predictors of wound complications requiring surgical intervention and developed a risk-scoring system that incorporates Enneking-Dunham resection type and tumor anatomic compartment extension. Patients were stratified into 3 risk categories: low (0 to 8 points), intermediate (9 to 13 points), and high (greater than or equal to 14 points). Wound complications requiring surgery occurred in 34% of the training cohort and 35% of the validation cohort. In the training cohort, rates of wound complications were 7.4%, 40%, and 67% in the low-, intermediate-, and high-risk groups, respectively (p < 0.001); rates were similar in the validation cohort (7.1%, 32%, and 49%; p < 0.001). The risk model demonstrated fair-to-good discriminative performance; the areas under the receiver operating characteristic curves were 0.83 (training cohort) and 0.71 (validation cohort) despite heterogeneity in tumor histology, reconstruction techniques, and perioperative management. We present the first externally validated prognostic staging system for predicting wound complications after internal hemipelvectomy. The model is simple, reproducible, and clinically applicable, allowing surgeons to preoperatively identify high-risk patients who may benefit from modified surgical approaches or prophylactic soft-tissue reconstruction. Further prospective studies are warranted to optimize management strategies for intermediate- and high-risk patients.