BackgroundSoft tissue sarcomas (STS) of the true pelvis are rare tumors andthere is little information in the literature related to management of these tumors.PurposeThe aim of this retrospective study was to review the literatureregarding the clinicopathological features and current management ofpelvic soft tissue sarcomas and to review the surgical experience of the National Cancer Institute in management of pelvic STS over the last 10 years.Twenty seven consecutive patients presenting between January 1997 and December 2006 with soft tissue sarcomas involving the true pelvis had undergone surgical resection in the Surgical Department of the National Cancer Institute, Cairo University. The data of these cases were collected and analysed.Results:Of the 27 patients, sixteen cases were males and eleven cases werefemales. The median age was 53.7 (range 12-65) years at presentation.The mean duration between the onset of symptoms and diagnosis was 8 months (range 1 month-48 months). The most frequent clinicalpresentation was abdominal or perineal pain representing 77.7% of all cases. The commonest pathological 2 types in our study were MFH (7 cases) and liposarcoma (6 cases). Cross-sectional imaging was reviewed for each patient to determine the anatomical location of the lesions. Only six cases in our study were limited to the true pelvis. Most of the cases were extending to the false pelvis (16 cases). Five cases were extendingto the thigh. Only one case was extending to the perineum. Externalhemipelvectomy was performed in only one case, internalhemipelvectomy was done in twelve cases, lower partial sacral resection was done in two cases, resection of the external iliac artery was done in two cases and visceral resection was done in six cases. The most commonly used approach was the abdominoinguinal approach (51.8% of cases). No perioperative mortality was recorded and the incidence of perioperative complications was 44.4% .The commonest encounteredcomplication was wound infection (6 cases). Adjuvant radiotherapy wasgiven in 25 cases, while adjuvant chemotherapy was given in 15 cases.The median time between operation and date of last follow up was 39 months (range 10-84 months). At last follow-up, 16 patients had died, 4 cases were alive with evidence of disease, and 7 cases were free of disease. Ten patients developed local tumor recurrence (37% of all cases).Seventeen patients developed distant metastases after treatment. The overall 3 years survival was 59.2%, and the overall 3 years disease free survival was 25.9%.Conclusions:Soft tissue sarcoma of the pelvis is fortunately a rare disease.Anatomical consideration and the often extensive size of these tumorsrepresent a challenge to proper treatment. It is generally agreed in the literature that complete surgical resection is the most important factor for cure or prolonged survival. Surgeons must be acqainted with the different approaches and reconstruction techniques to achieve the best results withleast morbidity.