En bloc resection of primary sacral tumors: classification of surgical approaches and outcome

The treatment of malignant skull base tumors has improved with the development of skull base surgical approaches that allow en bloc resection of a lesion and increase the efficacy of adjuvant therapies. The anatomical complexity of these lesions and their surroundings has led to a relatively high complication rate. Infection and cerebrospinal fluid fistulas are the most common serious procedure-related complications. They result from the frequent necessity of working in a contaminated space such as the paranasal sinuses as well as from the creation of large dural and skull base defects. The authors have reviewed the literature regarding complications of surgery for malignant skull base lesions and present several techniques and strategies for minimizing their incidence by performing the craniofacial approach to anterior skull base lesions.

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Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report

Operative Neurosurgery ◽

10.1093/ons/opab157 ◽

2021 ◽

Author(s):

Amanda N Sacino ◽

Sutipat Pairojboriboon ◽

Ian Suk ◽

Daniel Lubelski ◽

Robin Yang ◽

...

Keyword(s):

Mechanical Stability ◽

Pelvic Ring ◽

Surgical Techniques ◽

Extent Of Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Mobile Spine ◽

Sacral Tumors ◽

Fibrous Tumor

Abstract BACKGROUND AND IMPORTANCE En bloc resection of sacral tumors is the most effective treatment to help prevent recurrence. Sacrectomy, however, can be destabilizing, depending on the extent of resection. Various surgical techniques for improving stability and enabling early ambulation have been proposed. CLINICAL PRESENTATION Here, we report a case in which we use PMMA (poly[methyl methacrylate]) to augment pelvic instrumentation to improve mechanical stability after sacrectomy for en bloc resection of a solitary fibrous tumor. CONCLUSION We highlight the use of sacroplasty augmentation of pelvic ring reconstruction to provide biomechanical stability without the need for fusion of any mobile spine segments, which allowed for early patient ambulation and no appreciable loss of range of motion or mobility.

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Interest of Laparoscopy for “En Bloc” Resection of Primary Malignant Sacral Tumors by Combined Approach

Spine ◽

10.1097/brs.0000000000001069 ◽

2015 ◽

Vol 40 (19) ◽

pp. 1542-1552 ◽

Cited By ~ 4

Author(s):

Arnaud Dubory ◽

Gilles Missenard ◽

Benoît Lambert ◽

Charles Court

Keyword(s):

En Bloc Resection ◽

Bloc Resection ◽

Combined Approach ◽

En Bloc ◽

Sacral Tumors

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Transarterial Embolization Treatment of Sacral Tumors

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2018-0046 ◽

2018 ◽

Vol 1 (Supplement) ◽

pp. 35

Author(s):

D. Anghelescu ◽

E. Popescu ◽

A. Cursaru ◽

A. Dimitriu ◽

R. Ene ◽

...

Keyword(s):

Blood Loss ◽

Late Onset ◽

Transarterial Embolization ◽

En Bloc Resection ◽

Bloc Resection ◽

Recurrence Rates ◽

En Bloc ◽

Complete Excision ◽

Perioperative Blood Loss ◽

Sacral Tumors

Abstract Objectives. Sacral tumors represent about 1-4,3% of all bone tumors. They typically present with an abundance of blood vessels. Due to their anatomical localization, they are hard to approach surgically. Thus, a presurgical neoadjuvant therapy is indicated. The preoperative angiography with the embolization of the nutritive arteries decreases the perioperative blood loss and the symptomatology, and even decreases the volume of the tumors that cannot be surgically approached. Materials and methods. The principle of embolization consists in the targeting of the nutritive tumoral artery and in obturating it with embolic agents (polyvinyl alcohol, embospheres, etc.) through selective catheterization under angiographic control. The biopsy of the tumor is essential for certain diagnosis. The histological type of the tumor and the degree of differentiation influence the tumor’s physiopathology and often influence the therapeutic decision regarding its degree or recurrence. In some cases in which the tumor’s degree of extension increases the surgical risk, serial embolization can be used as a primary method of treatment. Because of the late onset symptomatology, when they are discovered they are extended and the degree of invasion in adjacent tissues is so high that it requires en bloc resection with nerve root sacrifice to assert complete excision and low recurrence rates. Results. The patients who undergo surgical treatment usually bleed, and the perioperative blood loss and the need for blood transfusion volumes were halved in the cases in which presurgical transarterial embolization was performed. Conclusions. Transarterial embolization of sacral tumors is a procedure indicated as a neoadjuvant presurgical therapy to decrease the blood loss risks and for the tumors that cannot be surgically removed it is used in the palliative treatment to reduce symptomatology.

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Is Piecemeal Endoscopic Resection Acceptable for Early Colorectal Cancers in Certain Situations? A Single-Center French Study

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-1568 ◽

2020 ◽

Vol 29 (3) ◽

pp. 353-360

Author(s):

Jean-Philippe Ratone ◽

Fabrice Caillol ◽

Christophe Zemmour ◽

Erwan Bories ◽

Christian Pesenti ◽

...

Keyword(s):

Endoscopic Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Single Center ◽

En Bloc ◽

Number Of Patients ◽

Single Center Study ◽

Center Study

Background and Aims: The use of endoscopic treatment for early colorectal cancer (ECC) is increasing. The European guidelines suggest performing piecemeal endoscopic resection (pmR) for benign lesions and en bloc resection for ECC, especially for patients with favorable lymph node involvement risk evaluations. However, en bloc resections for lesions larger than two centimeters require invasive endoscopic techniques. Our retrospective single-center study aimed to determine the clinical impact of performing pmR for ECC rather than traditional en bloc resection. Methods: A single-center study was performed between January 2012 and September 2017. All ECC patients were included. The main objective was to evaluate the number of patients who potentially underwent unnecessary surgery due to piecemeal resection. The secondary endpoints were as follows: disease-free survival (DFS), defined as the time from pmR to endoscopic failure (local recurrence not treatable by endoscopy), complication rate, number of patients who did not undergo surgery by default, and factors predictive of outcomes and complications. Results: One hundred and forty-six ECC endoscopically treated patients were included. In total, 85 patients were excluded (71 who underwent en bloc resection, 14 with pending follow-up). Data from 61 patients (33 women and 28 men) were analyzed. Two patients underwent potentially unnecessary surgery [3.28% (0.9%- 11.2%)]. The DFS rate was 87% (75%-93%) at 6 months and 85% [72%-92%] at 12 months. The median follow- up time was 16.5 months (12.4-20.9). Three patients (4.9%) had complications. One patient did not undergo surgery by default. A Paris classification of 0-2c (HR=9.3 (2.4-35.9), p<0.001) and Vienna classification of 5 [HR=16.3 (3.3-80.4), p<0.001] were factors associated with poor DFS. Conclusion: Performing pmR in place of en bloc resection for ECC had a limited impact on patients. If the pathology (especially deep margins) is analyzable, careful monitoring could be acceptable in ECC patients who undergo pmR.

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Midsacral Amputation for En Bloc Resection of Chordoma

Operative Neurosurgery ◽

10.1227/01.neu.0000365799.21610.c4 ◽

2010 ◽

Vol 66 (suppl_1) ◽

pp. ons-41-ons-44 ◽

Cited By ~ 3

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.

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Comparison of Esophagectomy outcomes between a National Center, a National Audit Collaborative, and an International database using the Esophageal Complications Consensus Group (ECCG) standardized definitions

Diseases of the Esophagus ◽

10.1093/dote/doaa060 ◽

2020 ◽

Author(s):

John V Reynolds ◽

Noel Donlon ◽

Jessie A Elliott ◽

Claire Donohoe ◽

Narayanasamy Ravi ◽

...

Keyword(s):

Anastomotic Leak ◽

En Bloc Resection ◽

Bloc Resection ◽

Leak Rate ◽

Surgical Approaches ◽

Consecutive Series ◽

Recurrent Nerve ◽

En Bloc ◽

Curative Intent ◽

Anastomotic Leak Rate

Summary The ECCG developed a standardized platform for reporting operative complications, with consensus definitions. The Dutch Upper Gastrointestinal Cancer Audit (DUCA) published a national comparison against these benchmarks. This study compares ECCG data from the Irish National Center (INC) with both published benchmark studies. All patients undergoing multimodal therapy or surgery with curative intent from 2014 to 2018 inclusive were studied, with data recorded prospectively and entered onto a secure online database (Esodata.org). 219 patients (mean age 67; 77% male) underwent open resection, 66.6% via transthoracic en bloc resection. 30-day and 90-day mortality were 0.0 and 0.9%,nrespectively. Anastomotic leak rate was 5.4%, pneumonia 18.2%, respiratory failure 10%, ARDS 2.7%, atrial dysrhythmia 22.8%, recurrent nerve injury 3%, and delirium in 5% of patients. Compared with both ECCG and DUCA, where MIE constituted 47 and 86% of surgical approaches, respectively, overall complications were similar, as were severity of complications; however, anastomotic leak rate was several-fold less, and mortality was significantly lower (P < 0.001). In this consecutive series and comparative audit with benchmark averages from the ECCG and DUCA publications, a low mortality and anastomotic leak rate were the key differential findings. Although not risk stratified, the severity of complications from this ‘open’ series is consistent with series containing large numbers of total or hybrid MIE, highlighting a need to adhere to these strictly defined definitions in further prospective research and randomized studies.

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Variations of en Bloc Resection for Advanced External Auditory Canal Squamous Cell Carcinoma: Detailed Anatomical Considerations

Cancers ◽

10.3390/cancers13184556 ◽

2021 ◽

Vol 13 (18) ◽

pp. 4556

Author(s):

Noritaka Komune ◽

Daisuke Kuga ◽

Koichi Miki ◽

Takashi Nakagawa

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Temporal Bone ◽

External Auditory Canal ◽

En Bloc Resection ◽

Bloc Resection ◽

Surgical Approaches ◽

Bone Resection ◽

En Bloc ◽

Temporal Bone Resection

Currently, only lateral temporal bone resection (LTBR) and subtotal temporal bone resection (STBR) are widely utilized for the surgical treatment of advanced squamous cell carcinoma of the external auditory canal (EAC-SCC). However, there are few descriptions of variations on these surgical approaches. This study aimed to elucidate the variations of en bloc resection for advanced EAC-SCC. We dissected the four sides of cadaveric heads to reveal the anatomical structures related to temporal bone resection. From the viewpoint of surgical anatomy, surgical patterns of temporal bone cutting can be divided into four categories: conventional LTBR, extended LTBR, conventional STBR, and modified STBR. Extended LTBR is divided into four types: superior, inferior, anterior, and posterior extensions. Several extension procedures can be combined based on the extension of the tumor. Furthermore, en bloc resection with the temporomandibular joint or glenoid fossa increases the technical difficulty of a surgical procedure because the exposure and manipulation of the petrous segment of the internal carotid artery are limited from the middle cranial fossa. Surgical approaches for advanced SCC of the temporal bone are diverse. They require accurate preoperative evaluation of the tumor extension and preoperative consideration of the exact line of resection to achieve marginal negative resection.

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Principles and techniques of en bloc vertebrectomy for bone tumors of the thoracolumbar spine: an overview

Neurosurgical FOCUS ◽

10.3171/foc.2003.15.5.7 ◽

2003 ◽

Vol 15 (5) ◽

pp. 1-6 ◽

Cited By ~ 16

Author(s):

Robert J. Bohinski ◽

Laurence D. Rhines

Keyword(s):

Bone Tumors ◽

Vertebral Column ◽

Thoracolumbar Spine ◽

Surgical Margin ◽

Surgical Oncology ◽

En Bloc Resection ◽

Bloc Resection ◽

Long Bone ◽

Surgical Approaches ◽

En Bloc

Oncological principles for en bloc resection of bone tumors were initially developed for tumors of the long bone by orthopedic surgical oncologists. Recently, spine surgeons have adopted these principles for the treatment of vertebral column tumors. The goal of en bloc resection is to establish a surgical margin that can be designated marginal or wide. In this article, the principles of surgical oncology for bone tumors of the spine are briefly reviewed and the different surgical approaches used to remove these tumors in an en bloc fashion are described in detail.

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