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Gaignard E, Tzanis D, Bouhadiba T, Kieser DC, Robin F, Bergeat D, Meunier B, Bonvalot S. Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas. BMC Surg 2019; 19:24. [PMID: 30786888 PMCID: PMC6381696 DOI: 10.1186/s12893-019-0488-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 02/18/2019] [Indexed: 01/06/2023] Open
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.
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Affiliation(s)
- Elodie Gaignard
- Service de chirurgie hépatobiliaire et digestive, CHU Rennes, CHU Pontchaillou, 2 rue Henri le Guilloux, 35033 Cedex 9, Rennes, France. .,Université de Rennes 1, Rennes, France. .,Department of Surgery, Institut Curie, PSL Research University, Paris, France.
| | - Dimitri Tzanis
- Department of Surgery, Institut Curie, PSL Research University, Paris, France
| | - Toufik Bouhadiba
- Department of Surgery, Institut Curie, PSL Research University, Paris, France
| | - David C Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Fabien Robin
- Service de chirurgie hépatobiliaire et digestive, CHU Rennes, CHU Pontchaillou, 2 rue Henri le Guilloux, 35033 Cedex 9, Rennes, France.,Université de Rennes 1, Rennes, France
| | - Damien Bergeat
- Service de chirurgie hépatobiliaire et digestive, CHU Rennes, CHU Pontchaillou, 2 rue Henri le Guilloux, 35033 Cedex 9, Rennes, France.,Université de Rennes 1, Rennes, France
| | - Bernard Meunier
- Service de chirurgie hépatobiliaire et digestive, CHU Rennes, CHU Pontchaillou, 2 rue Henri le Guilloux, 35033 Cedex 9, Rennes, France.,Université de Rennes 1, Rennes, France
| | - Sylvie Bonvalot
- Department of Surgery, Institut Curie, PSL Research University, Paris, France
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Carrère S, Tetreau R, Honoré C, Tzanis D, Delhorme JB, Fau M, Decanter G, Llacer C, Firmin N, Stoeckle E, Meeus P, Ferron G, Cupissol D, Quénet F, Meunier B, Bonvalot S. [What is the best management for a spermatic cord sarcoma in 2018?]. Prog Urol 2018; 29:12-17. [PMID: 30340845 DOI: 10.1016/j.purol.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/01/2018] [Accepted: 09/20/2018] [Indexed: 11/24/2022]
Abstract
Spermatic cord sarcomas are rare tumors for which the most important is the initial diagnostic procedure. They are frequently misdiagnosed after surgery for inguinal hernia, inguinal lymphadenectomy or testicular malignancy. Any clinical suspicion has to lead to perform imaging with MRI and a core needle biopsy in order to obtain an accurate preoperative diagnosis. Liposarcoma and leiomyosarcoma are the most common histological subtypes in elderly adults, rhabdomyosarcoma in children or in young adults. A CT scan will precede the treatment in order to look for distant metastasis and abdominal involvement. The therapeutic strategy as well as the surgical planning are then adapted to the histological, morphological and prognostic factors. Surgery is the cornerstone for the treatment of spermatic cord sarcoma. The minimum requirements for the surgical procedure are a wide excision of the tumor en bloc with radical orchidectomy, excision of the ipsilateral scrotum and high spermatic cord ligation. It could be enlarged to the anterior abdominal wall and adjacent organs some required a soft tissue flap. Spermatic cord sarcoma and trunk wall sarcoma have the same prognosis for which local recurrence could significantly decrease survival. Consequently, surgeon in charge with these tumors has to be familiar with soft tissue sarcoma and the management of these patients must be carried out under the supervision of a multidisciplinary team within the Netsarc network.
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Affiliation(s)
- S Carrère
- Service de chirurgie, institut régional du cancer de Montpellier (ICM), 208, avenue des apothicaires, 34298 Montpellier, France.
| | - R Tetreau
- Service de radiologie, institut régional du cancer de Montpellier (ICM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - C Honoré
- Service de chirurgie, institut Gustave Roussy (IGR), 114, rue Edouard Vaillant, 94800 Villejuif, France
| | - D Tzanis
- Service de chirurgie, institut Gustave Roussy (IGR), 114, rue Edouard Vaillant, 94800 Villejuif, France
| | - J-B Delhorme
- Service de chirurgie, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
| | - M Fau
- Service de chirurgie, centre Alexis Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - G Decanter
- Service de chirurgie, centre Oscar Lambret, 3, rue Fréderic Combemale, 59000 Lille, France
| | - C Llacer
- Service de radiothérapie, institut régional du cancer de Montpellier (IRCM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - N Firmin
- Service d'oncologie médicale, institut régional du cancer de Montpellier (IRCM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - E Stoeckle
- Service de chirurgie, insitut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - P Meeus
- Service de chirurgie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex, France
| | - G Ferron
- Service de chirurgie, institut universitaire du cancer de Toulouse, 1, avenue Irène Jollio-Curie, 31059 Toulouse cedex 9, France
| | - D Cupissol
- Service d'oncologie médicale, institut régional du cancer de Montpellier (IRCM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - F Quénet
- Service de chirurgie, institut régional du cancer de Montpellier (ICM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - B Meunier
- Service de chirurgie, centre hospitalo-universitaire de Rennes, 2, rue Henri Le Guilloux, 35033 Rennes, France
| | - S Bonvalot
- Service de chirurgie, institut Curie, 26, rue d'Ulm, 75248 Paris, France
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