Surgeries involving tumors with bony involvement of the pelvis, whether primary or secondary, present a major challenge. These cases typically require referral to the appropriate specialists and will typically involve an Orthopaedic Oncologist as well as a Surgical Oncologist. Multidisciplinary evaluation and care are essential to a satisfactory patient outcome; however, the bony involvement by tumors of the pelvis can be associated with a significant risk of complications and morbidity. This chapter outlines some of the major risks associated with pelvic bone tumor surgery, as well as potential complications and how to mitigate and/ or manage them.