Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas
Abstract Background Monobloc resection of soft tissue sarcomas (STSs) has a major impact on overall survival and local recurrence. Anatomical boundaries, such as the sciatic notch, increase the risk of fragmentation of the lesion. To date there are few papers describing the optimal surgical techniqu...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12893-019-0488-6 |
| _version_ | 1828374733647773696 |
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| author | Elodie Gaignard Dimitri Tzanis Toufik Bouhadiba David C. Kieser Fabien Robin Damien Bergeat Bernard Meunier Sylvie Bonvalot |
| author_facet | Elodie Gaignard Dimitri Tzanis Toufik Bouhadiba David C. Kieser Fabien Robin Damien Bergeat Bernard Meunier Sylvie Bonvalot |
| author_sort | Elodie Gaignard |
| collection | DOAJ |
| description | Abstract Background Monobloc resection of soft tissue sarcomas (STSs) has a major impact on overall survival and local recurrence. Anatomical boundaries, such as the sciatic notch, increase the risk of fragmentation of the lesion. To date there are few papers describing the optimal surgical technique to remove such STSs. The objective of this study is to describe a simultaneous anterior and posterior approach for resection of sciatic notch dumbbell tumours. Case presentation We present the surgical management of two patients diagnosed with well-differentiated liposarcomas of the sciatic notch with a retroperitoneal and gluteal extension in the two cases. Pre-operative diagnosis was made with a percutaneous biopsy including molecular analysis which demonstrated MDM2 amplification. We describe a simultaneous anterior and posterior approach, including the ligation of the posterior trunk of the internal iliac artery, to reduce intra-operative blood loss and devascularise the tumour. The anterior approach allows the evaluation of the tumour’s retroperitoneal extension, release from its pelvic attachments and control of the surrounding neurovascular structures. During the posterior approach, bleeding is reduced by the devascularisation of the gluteal musculature achieved with internal iliac artery ligation. Clear margins were achieved in both cases. No vascular, skeletal or soft tissue reconstructions were required. Conclusions Simultaneous combined anterior and posterior approaches to remove a malignant sciatic notch tumour optimises the chance of complete en bloc resection. This surgical strategy allows oncologic en bloc resection with minimal blood loss. |
| first_indexed | 2024-04-14T07:37:09Z |
| format | Article |
| id | doaj.art-c6bce3ed569541a990a4921ad94a1520 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-04-14T07:37:09Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-c6bce3ed569541a990a4921ad94a15202022-12-22T02:05:40ZengBMCBMC Surgery1471-24822019-02-011911610.1186/s12893-019-0488-6Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomasElodie Gaignard0Dimitri Tzanis1Toufik Bouhadiba2David C. Kieser3Fabien Robin4Damien Bergeat5Bernard Meunier6Sylvie Bonvalot7Service de chirurgie hépatobiliaire et digestive, CHU Rennes, CHU PontchaillouDepartment of Surgery, Institut Curie, PSL Research UniversityDepartment of Surgery, Institut Curie, PSL Research UniversityDepartment of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury District Health BoardService de chirurgie hépatobiliaire et digestive, CHU Rennes, CHU PontchaillouService de chirurgie hépatobiliaire et digestive, CHU Rennes, CHU PontchaillouService de chirurgie hépatobiliaire et digestive, CHU Rennes, CHU PontchaillouDepartment of Surgery, Institut Curie, PSL Research UniversityAbstract Background Monobloc resection of soft tissue sarcomas (STSs) has a major impact on overall survival and local recurrence. Anatomical boundaries, such as the sciatic notch, increase the risk of fragmentation of the lesion. To date there are few papers describing the optimal surgical technique to remove such STSs. The objective of this study is to describe a simultaneous anterior and posterior approach for resection of sciatic notch dumbbell tumours. Case presentation We present the surgical management of two patients diagnosed with well-differentiated liposarcomas of the sciatic notch with a retroperitoneal and gluteal extension in the two cases. Pre-operative diagnosis was made with a percutaneous biopsy including molecular analysis which demonstrated MDM2 amplification. We describe a simultaneous anterior and posterior approach, including the ligation of the posterior trunk of the internal iliac artery, to reduce intra-operative blood loss and devascularise the tumour. The anterior approach allows the evaluation of the tumour’s retroperitoneal extension, release from its pelvic attachments and control of the surrounding neurovascular structures. During the posterior approach, bleeding is reduced by the devascularisation of the gluteal musculature achieved with internal iliac artery ligation. Clear margins were achieved in both cases. No vascular, skeletal or soft tissue reconstructions were required. Conclusions Simultaneous combined anterior and posterior approaches to remove a malignant sciatic notch tumour optimises the chance of complete en bloc resection. This surgical strategy allows oncologic en bloc resection with minimal blood loss.http://link.springer.com/article/10.1186/s12893-019-0488-6SarcomaSciatic notchSurgeryAnterior approachPosterior approachSarcome |
| spellingShingle | Elodie Gaignard Dimitri Tzanis Toufik Bouhadiba David C. Kieser Fabien Robin Damien Bergeat Bernard Meunier Sylvie Bonvalot Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas BMC Surgery Sarcoma Sciatic notch Surgery Anterior approach Posterior approach Sarcome |
| title | Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas |
| title_full | Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas |
| title_fullStr | Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas |
| title_full_unstemmed | Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas |
| title_short | Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas |
| title_sort | simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas |
| topic | Sarcoma Sciatic notch Surgery Anterior approach Posterior approach Sarcome |
| url | http://link.springer.com/article/10.1186/s12893-019-0488-6 |
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