Malignant tumors involving the pelvis, including primary bone sarcomas, soft tissue sarcomas, and bone metastases, pose considerable diagnostic and therapeutic challenges. Compared to sarcomas of the extremities, pelvic tumors are associated with worse prognoses, largely due to delayed clinical presentation, absence of natural anatomic barriers, and proximity to critical neurovascular and visceral structures [1]. Surgical treatment typically requires wide resection to achieve oncologic control, a goal that must be carefully balanced against the preservation of function and QoL [[2], [3], [4]]. Depending on tumor location and extent, patients may undergo internal hemipelvectomy with or without reconstruction, or external hemipelvectomy (hindquarter amputation) involving resection of the hemipelvis and ipsilateral lower extremity [5]. These procedures are extensive and often followed by additional surgeries to address complications such as infection, local recurrence, delayed wound healing, or injury to adjacent nerves, bowel, or bladder [1,[6], [7], [8]]. While this operation can offer curative or life-prolonging benefits, it is associated with significant perioperative morbidity, prolonged rehabilitation, and long-term functional limitations [[9], [10], [11]]. Given its scope and impact, hemipelvectomy can lead to substantial physical, emotional, and psychological challenges for patients and their caregivers—burdens that remain underrepresented in the current literature and warrant further exploration from the patient perspective.

Most studies to date are focused on outcomes related to oncologic control, surgical complications, and function. While these endpoints are essential, they capture only part of the patient experience. Research on patient-reported outcomes (PROs) in this population is limited, often constrained by small sample sizes, short follow-up, and a narrow emphasis on ambulation and physical recovery [[9], [10], [11], [12]]. Broader domains, such as QoL, psychological adaptation, caregiver burden, and patient satisfaction, remain largely unexplored, despite their relevance to recovery. Patients frequently face loss of independence and prolonged reliance on caregivers, all of which can meaningfully influence their perception of care and long-term outcomes [13]. These gaps are compounded by growing administrative demands on surgeons and limited time for comprehensive preoperative counseling, which may hinder expectation-setting and leave patients underprepared for recovery [[14], [15], [16]].

This study was inspired by a recognition that recovery from major surgery often holds meaning for patients far beyond traditional clinical parameters [17]. Qualitative work by Rajabiyazdi et al. revealed that postoperative recovery after abdominal surgery, from the patient's perspective, is defined by return to daily routines, symptom resolution, regaining independence, overcoming mental strain, and enjoying life, rather than conventional measures like length of stay or readmission [18]. Their findings underscore the disconnect between common research outcomes and those valued by patients, reinforcing the need for patient-centered outcomes research in surgical care. Integrating these perspectives into shared decision-making and perioperative education may better align care with patient priorities and ultimately improve the recovery experience.

To address these gaps, we surveyed patients at least two years following hemipelvectomy for oncologic indications to better understand their lived experiences and long-term satisfaction with care. A structured Likert-style survey was used to evaluate multiple dimensions of care delivery, including the quality of preoperative education, involvement in decision-making, multidisciplinary support, coordination between providers, and caregiver preparedness. Physical function and overall QoL were assessed using validated patient-reported outcome measures. Our study aimed to answer the following questions: (1) What are the long-term impacts of hemipelvectomy on patients’ perceptions of physical function and overall QoL? (2) How do patients perceive the extent to which preoperative counseling prepared them for the recovery process? (3) How do patient perceptions of caregiver guidance and care coordination impact perceived long-term care burden?