Patients with malignant lumbosacral pelvic lesions present a difficult surgical challenge. Because of the insidious onset of symptoms, lesions are often diagnosed late in their course, and by that time they have attained a large size. Surgical resection is made more difficult by the complex surrounding anatomy and involvement of the sacral nerves responsible for bowel, bladder, and sexual function. Spinopelvic reconstruction is often required after resection. This article presents techniques for sacral resection and subsequent spinopelvic reconstruction. Biomechanical studies are summarized on construct stability, and recommendations are made as to when reconstruction is required. The expected bowel and bladder functional outcomes are summarized, based on the level of sacral resection.