October 4, 2010
John Theurer Cancer Center To Present Innovative Research At 2 Surgical Meetings
Nationally recognized orthopedic oncologist presents new surgical techniques to preserve bone and soft tissue in bone cancers
James C. Wittig, M.D. and colleagues will conduct a total of eight research presentations at the upcoming 96th Annual Clinical Congress of the American College of Surgeons and the 65th Annual Meeting of the American Society for Surgery of the Hand. Dr. Wittig, an orthopedic oncologist with extensive experience in performing limb-sparing surgeries, is Chief of the Division of Skin and Sarcoma Cancer of the John Theurer Cancer Center at Hackensack University Medical Center.The presentations will focus on unique surgical techniques for treating bone cancers that preserve as much bone and soft tissue as possible, while reducing complications, pain and chances of cancer recurrence. Among the techniques described is the use of endoprostheses that fit inside the bone "“ as well as cryosurgery and radiofrequency ablation, the use of electrical current to create heat that destroys tumors.
"At the John Theurer Cancer Center, we are proud of the fact that 95 percent of patients with orthopedic malignancies do not have to lose an arm or leg to cancer or a benign tumor if they undergo limb-sparing surgery," said Dr. Wittig. "We continue to refine these techniques, and it is our hope that research will enable us to make that number even higher."
The American College of Surgeons meeting will take place October 3-7, 2010 in Washington, DC, while the American Society for Surgery of the Hand meeting will be held October 7-9, 2010 in Boston, MA.
"Improving patient care through advancing research is key to the mission of the John Theurer Cancer Center," said Andrew L. Pecora, M.D., F.A.C.P., C.P.E., Chairman and Executive Administrative Director, John Theurer Cancer Center. "The research done by Dr. Wittig is critical to our fulfilling of that mission."
Podium-video presentations by Dr. Wittig's team at the American College of Surgeons meeting include:
Proximal Tibia Sarcoma: Limb-Sparing Resection, Prosthetic Reconstruction and Rotation of the Gastrocnemius Muscle. (9:45 am- 10/04/2010)
Researchers will describe a limb-sparing surgery of the lower leg's proximal tibia for a patient with primary malignant fibrous histiocytoma (MFH) of the bone. A modular segmental proximal tibia endoprosthesis was used to reconstruct the bony defect and knee joint. Surgeons achieved a 90 degree range of motion, with no complications. The researchers conclude that the surgical removal of tumors arising from the proximal tibia and reconstruction with modular prosthesis is a reliable and safe procedure.
Osteosarcoma of Distal Femur: Limb-Sparing Resection and Prosthetic. (10:00am- 10/04/2010)
Researchers performed a limb-sparing resection of the upper leg's distal femur for a patient with an osteosarcoma involving the distal femur and knee joint. A modular segmental distal femur prosthesis was used to reconstruct the knee joint. There were no complications after the surgery. At three years post-surgery, the patient's range of motion was full to 110 degree of flexion and full extension. No palpable masses were found and sensation was intact. Researchers conclude that limb-sparing surgery of the distal femur and endoprosthetic reconstruction is a safe technique that allows good function and local tumor control.
Chondrosarcoma of Proximal Femur: Limb-Sparing Resection and Prosthetic Reconstruction. (10:15am- 10/04/2010)
Dr. Wittig and colleagues performed a limb-sparing resection of a proximal femur for an 81-year-old male patient with chondrosarcoma. A modular segmental proximal femur tumor prosthesis was used, with emphasis on preservation of structures related to post-operative limb function, and to minimize infection. No complications were seen. Researchers conclude that proximal femur resection with endoprosthetic reconstruction is a complex surgical procedure, and that preservation of the acetabulum (hip socket) and joint capsule (sac surrounding the joint), capsulorrhaphy (suture of a tight closure of the joint capsule), and reconstruction of the abductor mechanism are major determinants of joint stability in resections. They observe that reconstruction can also be used for variety of nononcologic indications.
Extensive Squamous Cell Carcinoma of the Shoulder Girdle: Limb-sparing Total Scapula and Proximal Humerus (Tikhoff-Linberg Type) Resection with Prosthetic and Soft Tissue Reconstruction. (10:45am- 10/04/2010)
A limb-sparing (Tikhoff-Linberg) resection of a total left scapula and the proximal humerus, bones that are part of or connected to the shoulder, was performed on a 60-year-old male patient with fungating basal squamous cell carcinoma. The proximal humerus was reconstructed with a modular segmental proximal humerus tumor prosthesis. The goal of this shoulder girdle reconstruction was to provide a stable shoulder and to preserve elbow and hand function. After surgery, the patient had limited range of motion at the shoulder, and full range of motion at the elbow and wrist. No masses were palpable over the site of the surgery.
Radiofrequency Ablation of an Osteoid Osteoma of Calcaneus Bone. (11:00am- 10/04/2010)
An osteoid osteoma (OO) in the calcaneus (heelbone) of a young female patient was treated in a minimally invasive manner with CT-guided radiofrequency ablation (RFA). The patient had complete pain relief after the procedure and returned to normal activity within one week, with no complications. The researchers conclude that RFA for osteoid osteomas is a reliable procedure with a low complication rate.
Sacrococcygeal Chordoma: Intralesional Resection and Cryosurgery. (11:15am- 10/04/2010)
Dr. Wittig and colleagues performed an intralesional tumor removal (resection) and cryosurgery on an 84-year-old woman with a sacral chordoma, a tumor at the base of the spine, involving vertebrae S3 to S5. The procedure was performed instead of a more radical complete sacrectomy, the standard procedure. No nerve dysfunction or infection was seen post-surgery. On follow up after two years, there was no evidence of recurrence of the tumor. Researchers conclude that cryosurgery is an effective adjuvant treatment for bone tumors, because it destroys microscopic cancer cells with a low rate of complication.
Video presentations by Dr. Wittig and colleagues at the American Society for Surgery of the Hand meeting include:
Intra-articular Resection and Reconstruction with Modular Segmental Proximal Humerus Prosthesis for a Pathologic Fracture. (15 min- Oct 07-09)
Surgery was performed on a patient with a pathologic fracture of his right proximal humerus due to metastatic renal cell carcinoma. Medical imaging showed this fracture of the proximal humerus with a large soft tissue component. Dr. Wittig and colleagues performed an intra-articular (within the joint) resection of the right proximal humerus, using a segmental proximal humerus tumor prosthesis for reconstruction. The goal of the reconstruction was to provide a painless and stable shoulder girdle for optimal hand and elbow function without compromising rotation. Static and dynamic methods of soft tissue reconstruction were employed to stabilize the prosthesis and cover the prosthesis with soft tissue to optimize function and minimize complications. This patient has been pain-free and has had normal elbow and hand function, with no dislocations. The shoulder has been stable.
Limb-Sparing Total Scapula and Proximal Humerus (Tikhoff-Linberg Type) Resection with Prosthetic and Soft Tissue Reconstruction. (15 min- Oct 07-09)
A 60-year-old male patient who presented with a fungating squamous cell carcinoma involving his shoulder girdle, was found to have extensive loss of soft tissue overlying the scapula, clavicle, and proximal humerus. The tumor had also invaded these bony structures in several locations. The patient underwent a radical resection of the left scapula as well as the proximal humerus including the deltoid, rotator cuff muscles, and portions of the trapezius and the clavicle instead of a forequarter amputation. A modular proximal humerus tumor prosthesis was used as a spacer and to permit stabilization of the extremity, and optimize hand and elbow function. All margins were free of cancer. The patient now has a stable shoulder girdle and can use his hand and elbow, with minimal discomfort.
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