scholarly journals Comparison of Oncologic Outcomes and Treatment-Related Toxicity of Carbon Ion Radiotherapy and En Bloc Resection for Sacral Chordoma

2022 ◽  
Vol 5 (1) ◽  
pp. e2141927
Author(s):  
Yagiz U. Yolcu ◽  
Jad Zreik ◽  
Waseem Wahood ◽  
Atiq ur Rehman Bhatti ◽  
Mohamad Bydon ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Carbon Ion Radiotherapy ◽  
Oncologic Outcomes ◽  
En Bloc ◽  
Carbon Ion ◽  
Sacral Chordoma

Conversion of high sacral to midsacral amputation via S-2 nerve preservation during partial S-2 sacrectomy for chordoma

2014 ◽  
Vol 20 (4) ◽  
pp. 421-429 ◽  
Author(s):  
Rajiv Saigal ◽  
Daniel C. Lu ◽  
Donna Y. Deng ◽  
Dean Chou
Keyword(s):  
Sexual Function ◽  
Functional Outcome ◽  
Nerve Root ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Nerve Roots ◽  
En Bloc ◽  
Risk Of Recurrence ◽  
Nerve Preservation ◽  
Sacral Chordoma

Chordomas of the sacrum require en bloc resection to reduce the risk of recurrence, but this may sacrifice nerves vital to bladder, bowel, and sexual function. High, mid-, and low sacral amputations have been previously classified based on nerve root sacrifice, not bony amputation. Sacrifice of the S-2 nerves or those above results in a high sacral amputation, but preserving the S-2 nerves converts it into a midsacral amputation. Preservation of the S-2 nerves has been shown to improve functional outcome, despite the bony osteotomy being unchanged. Thus, keeping the same bony amputation while preserving the S-2 nerve roots may allow for improved functional outcome while still achieving the same goal of oncological resection. Preservation of the S-2 nerves may be particularly difficult during amputation at the S-2 pedicle or above, and the authors describe their technique for preserving the S-2 nerves during partial sacrectomy at or just above the S-2 pedicle. Four cases of sacral chordoma resections are presented to illustrate the technique.

Metastasectomy for melanoma in the VATS era

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20001-e20001
Author(s):  
A. Bhargava ◽  
M. J. Schuchert ◽  
D. O. Wilson ◽  
R. J. Landreneau ◽  
J. D. Luketich ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Wedge Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Open Group ◽  
Oncologic Outcomes ◽  
Open Approach ◽  
En Bloc ◽  
Curative Intent ◽  
Perioperative Morbidity

e20001 Background: The role for metastasectomy in the setting of metastatic melanoma remains ill-defined. The aim of this study is to evaluate resection of limited metastases in the setting of melanoma comparing VATS and open approaches, specifically looking at perioperative morbidity and survival. Methods: All patients undergoing metastasectomy for melanoma with curative intent between January 1, 2001 and September 30, 2007 were included. Data was collected retrospectively from the UPMC tumor registry and chart review. Differences between groups were compared with the student's t-test. Results: Of 43 patients undergoing metastasectomy for melanoma, 31 patients were resected with intent to cure (16 VATS, 15 open). Complications were similar between the VATS (12%) and open (13%) groups. There were no perioperative deaths in either group. The median survival in the VATS group was 20.7 months, compared to 26.5 months in the open group (p = 0.17). Importantly, the VATS patients more frequently underwent resection of smaller, peripheral lesions via wedge resection (81%) and only 2 patients (13%) underwent lobectomy. Conversely, patients undergoing open procedures were more likely to have larger, more central lesions and undergo anatomic resections. There were 9 (60%) lobectomies, 3 (20%) segmentectomies 1 (7%) en bloc resection and only 2 (13%) wedge resections in the open group. Conclusions: Metastasectomy for metastatic melanoma in the thoracic cavity can be performed safely by a VATS or open approach. The two approaches have comparable morbidity, mortality and survival outcomes. Careful patient resection remains the hallmark of care in identifying appropriate candidates for metastasectomy. In the setting of patients with short life-expectancy, it may be advantageous to employ a VATS approach when possible to preserve quality of life while achieving similar oncologic outcomes to open procedures. Individuals with a radiographic indication of limited peripheral disease should be considered for a VATS approach to resection of melanoma metastases. No significant financial relationships to disclose.

Partial Sacrectomy for Resection of a Sacral Chordoma: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E412-E412
Author(s):  
Martin Julian Gagliardi ◽  
Alfredo Guiroy ◽  
Alfredo Sícoli ◽  
Nicolás Gonzalez Masanés ◽  
Alejandro Morales Ciancio
Keyword(s):  
Osteolytic Lesion ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Wide Resection ◽  
Resection Margins ◽  
Low Grade ◽  
En Bloc ◽  
Ct Guided ◽  
Sacral Chordoma ◽  
Sacrococcygeal Region

Abstract Sacral chordomas are infrequent tumors that arise from remnants of the notochord. They are most often found in the sacrum and skull-base.1,2 These lesions rarely metastasize and usually have an indolent and oligosymptomatic clinical course. Chordomas show low sensitivity to standard radiation therapy and chemotherapy. Operative resection with wide resection margins offers the best long-term prognosis, including longer survival and local control.1,3 However, achieving a complete resection with oncological margins may be difficult because of the anatomic complexity of the sacrococcygeal region.4 The main complications of sacral resection include infections, wound closure defects, and anorectal and urogenital dysfunction. The rate of these complications is significantly increased when the tumor involves the S2 level or above. We report the case of a 64-yr-old male who presented with progressive sacrococcygeal pain and a feeling of incomplete evacuation. A heterogeneous, osteolytic lesion was found at the sacrococcygeal region. Full body imaging tests were negative for other lesions. A computed tomography (CT) guided biopsy was made. We usually use the midline approach in case we have to include the needle path in the resection. The pathology confirmed a sacrococcygeal, low-grade chordoma. We decided to perform an en bloc resection. A posterior, partial sacrectomy was planned distal to the S4 level.

Midsacral Amputation for En Bloc Resection of Chordoma

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-41-ons-44 ◽  
Author(s):  
Ganesh Rao ◽  
George J. Chang ◽  
Ian Suk ◽  
Ziya Gokaslan ◽  
Laurence D. Rhines
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Margins ◽  
En Bloc ◽  
Sacral Chordoma ◽  
Sacral Tumor ◽  
Tumors Of The Sacrum ◽  
Successful Removal ◽  
Sacral Tumors

Abstract Background: En bloc resection, with adequate surgical margins, of primary malignant bone tumors of the sacrum is associated with long term disease control and potential cure. Resection of sacral tumors is difficult due to the proximity of neurovascular and visceral structures, and complete, or even partial, sacrectomy often results in functional loss for the patient. Objective: We describe the technique for en bloc resection of a sacral chordoma through a mid-sacral amputation. Results: We demonstrate successful removal of a large sacral tumor with wide surgical margins while preserving neurologic function. Conclusion: This technique for midsacral amputation to remove a sacral tumor en bloc minimizes local recurrence and maximizes neurovascular function.

scholarly journals Laparoscopic Nephroureterectomy and Management of the Distal Ureter: A Review of Current Techniques and Outcomes

2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
Davis P. Viprakasit ◽  
Amanda M. Macejko ◽  
Robert B. Nadler
Keyword(s):  
Transitional Cell ◽  
Cancer Control ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Oncologic Outcomes ◽  
En Bloc ◽  
Distal Ureter ◽  
Perioperative Morbidity ◽  
Laparoscopic Nephroureterectomy

Laparoscopic nephroureterectomy (LNU) is becoming an increasingly common alternative treatment for transitional cell carcinoma (TCC) of the renal pelvis and ureter due to decreased perioperative morbidity, shorter hospitalization, and comparable oncologic control with open nephroureterectomy (ONU). Mobilization of the kidney and proximal ureter may be performed through a transperitoneal, retroperitoneal, or hand-assisted approach. Each technique is associated with its own benefits and limitations, and the optimal approach is often dictated by surgeon preference. Our analysis of the literature reflects equivalent cancer control between LPN and OPN at intermediate follow-up with significantly improved perioperative morbidity following LPN. Several methods for bladder cuff excision have been advocated, however, no individual technique for management of the distal ureter proved superior. Overall, complete en-bloc resection with minimal disruption of the urinary tract should be optimized to maintain oncologic outcomes. Longer follow-up and prospective studies are needed to fully evaluate these techniques.

scholarly journals Rare case of neglected large sacral Chordoma in a young female treated by wide En bloc resection and Sacrectomy

BMC Cancer ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Zi Hao Phang ◽  
Xue Yi Saw ◽  
Noreen Fadzlina Binti Mat Nor ◽  
Zolqarnain Bin Ahmad ◽  
Sa’adon Bin Ibrahim
Keyword(s):  
Rare Case ◽  
En Bloc Resection ◽  
Young Female ◽  
Bloc Resection ◽  
En Bloc ◽  
Sacral Chordoma

Local recurrence after S2–3 sacrectomy in sacral chordoma

2002 ◽  
Vol 97 (1) ◽  
pp. 98-101 ◽  
Author(s):  
Ken Ishii ◽  
Kazuhiro Chiba ◽  
Masahiko Watanabe ◽  
Hiroo Yabe ◽  
Yoshikazu Fujimura ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Gluteus Maximus ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Piriformis Muscle ◽  
En Bloc ◽  
Content Type ◽  
Sacral Chordoma ◽  
Lateral Portion ◽  
Preoperative Magnetic Resonance

✓ Excision is the treatment of choice in cases of sacral chordoma. Local recurrences, however, have often been observed even after total en bloc resection. The authors assessed outcomes in four cases of tumor recurrence in patients who underwent total en bloc S2–3 resection for sacral chordomas that were located below S-3. The primary recurrences were located at either side of the lateral portion of the remaining sacrum in all patients. In two patients in whom preoperative magnetic resonance imaging indicated no invasion of the tumor into surrounding soft tissues, recurrence in the resected end of the gluteus maximus or piriformis muscle was also observed. The authors therefore recommend that the S2–3 sacrectomy should be performed over an adequate margin, including a part of sacroiliac joints at the bilateral portions of the sacrum and soft tissues such as the gluteus maximus or piriformis muscle.

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