Surgical Oncology 32 (2020) 69–74 Available online 20 November 2019 0960-7404/© 2019 Elsevier Ltd. All rights reserved. The intraoperative use of aortic balloon occlusion technique for sacral and pelvic tumor resections: A case-control study Nicola Ratto a, * , Michele Boffano a , Pietro Pellegrino a , Andrea Conti a , Laura Rossi d , Valter Verna b , Valentina Rastellino c , Maurizio Berardino c , Raimondo Piana a a Oncologic Orthopaedic Surgery Division, CTO Hospital - AOU Citt� a della Salute e della Scienza di Torino, Italy b Radiology Division of San Lazzaro Hospital, Alba, Italy c Intensive Care Unit, CTO Hospital AOU Citt� a della Salute e della Scienza di Torino, Italy d Clinical Research Coordinator, Fondazione per la ricerca Sui Tumori dell’apparato Muscoloscheletrico e rari Onlus, Turin, Italy A R T I C L E INFO Keywords: Aortic balloon occlusion Pelvic and sacral tumor Blood loss ABSTRACT Introduction: Pelvic and sacral tumor surgery is traditionally characterized by several major complications. Bleeding is probably the most feared and dreadful complication. The aim of the study was to evaluate whether the intraoperative use of the intra-aortic balloon occlusion technique could decrease the perioperative blood loss. A secondary aim was to assess aortic balloon-related complications. Materials and methods: From January 2014 to December 2017 15 patients (Group 1) treated with intra-aortic balloon infation were prospectively enrolled and compared to a historical control group (Group 2) of 11 pa- tients with similar surgeries. Number of blood units transfused, perioperative hemoglobin values, hours spent in intensive care unit (ICU), length of inpatient stay, and perioperative complications were evaluated. Results: Intraoperatively, a mean of 6.1 blood units per patient (BUPP) was used in Group 1 and 16.2 BUPP in Group 2. Postoperatively the averages were 2,8 and 5,4 BUPP in Group 1 and 2, respectively. Patients in Group 1 had a faster recovery in hemoglobin values, as well as a shorter length of overall inpatient stay (28,9 vs 59 days) and of ICU stay (33.9 vs 74.6 h). The most relevant complications observed in Group 1 were two thrombosis at the incannulation site that required a surgical arterial thrombectomy. Conclusion: The intra-aortic balloon occlusion is an effective technique to control bleeding during the resections of huge pelvic and sacral tumors. A proper training of a multidisciplinary team and an accurate patient selection are required to prevent major complications. 1. Introduction The management of bone and soft tissue tumors of the pelvis and sacrum requires a multidisciplinary team made up of surgeons, anes- thesiologists, radiologists, oncologists, and radiotherapists, in order to reduce perioperative complications and to improve short- and long- terms of long-term survival [1]. The surgical treatment is often very demanding and it has a high risk of major and potentially fatal com- plications, due to the volume reached by the tumor and the complexity of the anatomical region. In fact, these lesions have a huge space where to grow and develop symptoms only when they become very large. This particular anatomy and the rich blood supply of the pelvis can lead to signifcant intraoperative blood loss, up to 10,000 mL [2]. The bleeding control is essential to avoid complications such as anemia, hemorrhagic shock and also to improve the view of the surgical feld and of the main anatomical structures. Several solutions could be used to achieve a better control of bleedings in pelvic and sacral surgery. However, the oncological patient is not an optimal candidate for a predeposit autologous donation, and, moreover, the intraoperative re- covery technique is not currently recommended [3]. The controlled hypopressure technique is commonly used but the preservation of organ perfusion has to be taken into consideration. An accurate intraoperative anesthesia monitoring should be able to maintain a low mean arterial pressure, enough to reduce bleeding without suppressing self-regulation, which preserves organ perfusion. Therefore, this tech- nique could be diffcult to apply continuously and could jeopardize blood perfusion for vital organs, in particular central nervous system, heart and kidneys [4]. Surgical ligation of the common iliac arteries * Corresponding author. AOU Citt� a della Salute e della Scienza di Torino CTO Hospital, Via Zuretti, 29, 10126, Torino, Italy. E-mail address: nicolaratto@hotmail.com (N. Ratto). Contents lists available at ScienceDirect Surgical Oncology journal homepage: http://www.elsevier.com/locate/suronc https://doi.org/10.1016/j.suronc.2019.11.003 Received 2 August 2019; Received in revised form 20 October 2019; Accepted 17 November 2019