Multi-Step Combined Upfront Surgery for Locally Advanced Paravertebral Sarcoma: A Case Report

• Main Authors: Umberto Cariboni, Nicolò Gennaro, Francesco Costa, Salvatore Lorenzo Renne, Pierluigi Novellis, Andrea Marrari, Alexia Francesca Bertuzzi, Efrem Civilini
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2021-04-01
• Series: Frontiers in Surgery
• Subjects: sarcoma; multidisciplinary (treatment); UPS; surgery; aorta–thoracic; vertebra bone
• Online Access: https://www.frontiersin.org/articles/10.3389/fsurg.2021.664089/full

Background: Paravertebral localization of primary undifferentiated pleomorphic sarcoma (UPS) with bone and vascular involvement is infrequent and challenging. Multi-step surgical procedure has been described as a feasible and effective option to achieve sustained local tumor control.Methods: We report on a 62-year old man with paravertebral UPS infiltrating the aortic wall and the 9th thoracic vertebra who underwent a multi-step surgical procedure aimed at achieving oncologic radicality through a coordinated effort between thoracic, vascular and spinal surgeons. After balancing the risks and benefits of perioperative therapies, upfront surgery was performed including aortic resection with bypass grafting followed by a triple en bloc vertebrectomy with tumor excision. Mid-term follow-up (22 months) is then provided.Results: The combined procedure achieved oncological radicality and no local recurrence in the mid-term. No major complications occurred.Conclusions: Multi-step and multi-specialty surgery is a feasible and effective strategy to treat primary UPS in unfavorable localization. A strategic cooperation between surgeons and a multidisciplinary tumor board is required to define an optimal, personalized treatment strategy in sarcoma patients.