Background: The purpose of this study is to investigate feasibilities of intra-aortic balloon occlusion (IABO) for pelvic and sacrum tumors, focusing on the advantages and precautions of the technique. Methods: From January 2010 to December 2013, among all patients with sacrum or pelvic tumor, 46 underwent surgery adjuvant with IABO. We retrospectively reviewed the medical records of these patients, including characteristics, intraoperative hemorrhage, transfusion, serum potassium, arterial lactic acid, postoperative complication, tumor recurrence or metastasis at a follow-up of 28.2 months. Results: Balloons for 46 patients were successfully placed, and the average intraoperative hemorrhage was 1.8 (1.2-3.0) l. Intraoperatively, arterial lactic acid increased from baseline (1.69±0.68) mmol/l to (2.11±0.82) mmol/l (P=0.17) during occlusion and (3.50±2.70) mmol/l (P=0.02) after deflation. While serum potassium concentration showed a trend of increase, but the change was not significant. Application of the technique helped create a bloodless surgical field and shorten the operative time. 9 patients regained normal defecation, while 2 patients with preoperative numbness of perineum developed new onset urinary and fecal incontinence after surgery. Postoperatively, 5 patients developed wound infection, 1 patient developed lower limb weakness, and 1 patient developed cerebrospinal leak. During 28.2 months' followup, 5 recurrences and 2 metastases occurred. Conclusions: IABO might be a choice to reduce intraoperative bleeding, create a clear view of the anatomical structures, shorten the operative time and limit postoperative complication in resection of pelvic and sacrum tumor. Nevertheless, anesthesiologists and surgeons should be sensitive to hemodynamic parameters, electrolyte balance as well as acid-base balance during the procedure, especially after deflation of the balloon. (Funded by the