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Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas

Authors
  • Gaignard, Elodie1, 2, 3
  • Tzanis, Dimitri3
  • Bouhadiba, Toufik3
  • Kieser, David C.4
  • Robin, Fabien1, 2
  • Bergeat, Damien1, 2
  • Meunier, Bernard1, 2
  • Bonvalot, Sylvie3
  • 1 CHU Rennes, CHU Pontchaillou, Service de chirurgie hépatobiliaire et digestive, 2 rue Henri le Guilloux, 35033 Cedex 9, Rennes, France , Rennes (France)
  • 2 Université de Rennes 1, Rennes, France , Rennes (France)
  • 3 Institut Curie, PSL Research University, Department of Surgery, Paris, France , Paris (France)
  • 4 Canterbury District Health Board, Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch, New Zealand , Christchurch (New Zealand)
Type
Published Article
Journal
BMC Surgery
Publisher
BioMed Central
Publication Date
Feb 20, 2019
Volume
19
Issue
1
Identifiers
DOI: 10.1186/s12893-019-0488-6
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundMonobloc 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 presentationWe 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.ConclusionsSimultaneous 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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