F H Sim

Mayo Foundation for Medical Education and Research, Scottsdale, AZ, United States

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Publications (357)852.07 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Multiple myeloma is a malignancy of monoclonal plasma cells (plasma cells are of B-lymphocyte lineage of the hematopoietic system). It is the second most prevalent blood malignancy after non-Hodgkin's lymphoma. It accounts for approximately 1 % of all malignancies and 2 % of all cancer deaths. Bony involvement is very common; the incidence of pelvic and periacetabular involvement in MM is reported to be around 6 %. Lytic lesions comprise a hallmark of multiple myeloma, which may be complicated with pathologic fractures in a substantial percentage of patients. Pelvic and periacetabular bony involvement of multiple myeloma is associated with some unique characteristics regarding the biomechanics of this specific anatomical region, the morbidity, the overall survival, and prognosis, which all reflect to impairment of quality of life. In this paper, we review the special features of multiple myeloma lesions around the pelvis and acetabulum and present an algorithm of management with the use of current surgical techniques.
    European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. 10/2014;
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    ABSTRACT: Aneurysmal bone cysts (ABCs) are a benign aggressive tumor that occurs rarely in the pelvis in the pediatric population. Pelvic ABCs may involve the triradiate cartilage and/or the acetabulum, which increases the technical difficulty of surgical treatment and has potential implications on the growth and development of the hip joint. This study examines the clinical presentation, rate of surgical complications, and recurrence rate, as well as, long-term clinical and functional outcomes of children with pelvic ABCs treated at a single institution by a single treatment modality. Between 1988 and 2008, 142 children with histologically confirmed ABCs were treated at our institution. Seventeen (12 %) tumors were located in the pelvis. A total of 13 pelvic ABCs (5 ilium-periacetabular, 4 pubic, 3 ilium-iliac wing, and 1 ischium) were included in this study. There were eight male and five female patients with a mean age of 12.9 years (range 4.1-17.5 years) at the time of surgery. The Toronto Extremity Salvage Score (TESS), the Musculoskeletal Tumor Society 1993 (MSTS'93) score, and the Short Form Health Survey Sf-36 were obtained at a minimum 5-year follow-up in all patients (mean follow-up 11.5 years, range 5.5-19.8 years). The mean age at follow-up was 24.3 years (range 14.6-32.6 years). All patients were treated surgically with intralesional curettage extended with a high-speed burr and bone grafting. Eight patients received adjunctive therapy with phenol. Five patients had preoperative selective arterial embolization. Of the 13 patients, 1 had a local recurrence diagnosed at 6 months after surgery. The only complication in the cohort was a superficial wound infection. At the latest follow-up, all patients were free of disease. The mean TESS score was 95 and the mean MSTS'93 score was 93 %. The mean self-rated general health score, according to the SF-36 was 87 % of total points possible. Extended curettage and bone grafting of pelvic ABCs in the pediatric population can yield high clinical and functional scores at an average of 11 years follow-up with a low rate of complications and recurrence. IV, case series.
    Journal of Children s Orthopaedics 05/2014;
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    ABSTRACT: To determine if aerosol granulocyte macrophage-colony-stimulating factor (GM-CSF) decreases the 2-year pulmonary metastasis rate for soft tissue sarcoma. Patients with high-grade soft tissue sarcomas were treated with 2 cycles of ifosfamide, mitomycin, doxorubicin, and cisplatin plus GM-CSF subcutaneous followed by 45 Gy irradiation with concurrent 2 cycles of mitomycin, doxorubicin, and cisplatin followed by surgery +/- intraoperative radiation or brachytherapy. Aerosol GM-CSF (250 mcg twice a day) was administered for 1 week every other week 3× during neoadjuvant therapy and beginning 4 weeks postoperatively every other week 5×. A total of 39 patients were enrolled between November 2001 and April 2006. The median age was 51 years (range, 19 to 65 y). The median lesion size was 9 cm (range, 2.3 to 26.7 cm). Seventy-six percent experienced grade 3-4 hematologic toxicity. Twenty-four of the first 35 evaluable patients (69%; 95% CI, 41%-84%) were free of pulmonary metastasis at 2 years. A total of 82% (95% CI, 70%-95%) of patients were still alive after 3 years, with a median follow-up of 5.5 years (range, 3.4 to 7.6 y). A total of 58% (95% CI, 44%-76%) of patients remained progression free after 3 years. The addition of aerosol GM-CSF to combined chemotherapy, irradiation, and surgery for soft tissue sarcomas did not achieve the study endpoint to decrease the 2-year pulmonary metastasis rate.
    American journal of clinical oncology 01/2014; · 2.21 Impact Factor
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    ABSTRACT: The objectives of this study were to describe the authors' experience with the timeline for prosthetic fitting after rotationplasty of the knee and to determine factors that may be associated with earlier prosthetic fitting. The authors conducted a retrospective observational study of 12 patients who underwent rotationplasty of the knee and received prosthetic care at this institution. All patients had oncologic causes for surgery. The median age at amputation was 10 yrs. The overall survival rate was 92%. Five patients received a preliminary bypass prosthesis. All 12 patients were successfully fitted with a definitive prosthesis. Three patients were fitted within 90 days; two of these three patients did not require chemotherapy. The median time for definitive prosthetic fitting in the ten patients requiring chemotherapy was 230.5 days (range, 85-425 days). Nine patients had documentation supporting a return to sport/premorbid physical recreational activities. In the authors' experience, chemotherapy was associated with delayed definitive prosthetic fitting. Typically, the patients who required rotationplasty for cancer completed fitting with a definitive prosthesis in 6 mos. The findings of this study validate previous reports and confirm that most rotationplasty patients have excellent outcomes with return to premorbid physical activities.
    American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 01/2014; · 1.56 Impact Factor
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    ABSTRACT: Malignant tumors of the proximal part of the fibula are rare. We sought to analyze the presenting characteristics, postoperative complications, and local recurrences of malignant tumors in the proximal part of the fibula in a large series of patients. We identified 112 histologically confirmed malignant tumors of the proximal part of the fibula from the time period between 1910 and 2007. The sex ratio was nearly equal (fifty-four male, fifty-eight female). The average age of the patients was 27.6 years, and the average follow-up period was 5.7 years. Osteosarcoma (44%) was the most common diagnosis. Pain (86%), palpable mass (51%), and peroneal nerve symptoms (12%) were the most common presenting symptoms. One hundred and three (92%) of 112 underwent curative surgical treatment. The two most common procedures were amputation in fifty (45%) of 112 patients and Malawer type-II resection in twenty-four (21%) of 112 patients. Deliberative sacrifice of the peroneal nerve was performed in seventy-four patients (66%). Postoperative complications occurred in fourteen (12.5%) of 112 patients, including wound issues (ten of 112), peroneal nerve palsy despite nerve preservation (two of twenty-nine), and posterior tibial artery thrombosis (two of 112). No long-term knee instability was seen in the fifty-three patients who underwent resection with lateral collateral ligament reconstruction. Fifty-six patients (50%) developed distant metastases and twelve (11%) had local recurrences. Osteosarcomas are the most common malignant tumor of the proximal fibula. Complication rates are modest and long-term knee instability was not seen in patients undergoing reconstruction of the lateral collateral ligament. Local recurrence following resection is not uncommon and metastatic dissemination is the main cause of death. This series represents the largest collection of such tumors for which there is extended follow-up and data on surgical complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 11/2012; 94(22):e1651-8. · 3.23 Impact Factor
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    Alex Senchenkov, Franklin H Sim
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    ABSTRACT: Limb salvage procedures in previously operated, radiated, and vessel-depleted fields rely heavily on the use of microvascular tissue transfer. This report illustrates the feasibility of the use of ovarian vessels for the revascularization of a free flap. We have achieved success with the use of rectus abdominis muscle free flap for coverage of exposed vascular reconstruction in the 75-year-old soft tissue sarcoma patient with twice chemoradiated femoral and hypogastric defect, preventing external hemipelvectomy. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.
    Microsurgery 11/2012; · 1.62 Impact Factor
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    ABSTRACT: Pelvic radiation has been commonly used to treat gastrointestinal, genitourinary, or hematopoietic malignancies. Conventional THA in these patients reportedly have high rates of fixation failure. Although secure short-term fixation reportedly occurs with trabecular metal implants following pelvic radiation, it is unclear whether the fixation is durable. We determined the survival of trabecular metal acetabular components in patients having THA following pelvic radiation and assessed function and radiographic loosening. We retrospectively reviewed 29 patients with prior pelvic radiation who had 34 arthroplasties using trabecular metal acetabular components from 1998 and 2005. The mean pelvic radiation dose was 6300 cGy. We collected the following data: patient demographics, surgery and implant information, clinical and radiographic followup, and tumor and radiotherapy related details. We obtained Harris hip scores (HHS) on all patients. Ten patients died of disease prior to 5 years and two patients were excluded, leaving 17 patients (22 hips) with a minimum of 5 years of clinical (mean, 78 months; median, 71; range, 57-116) and radiographic (mean, 73; median, 65; range, 51-116) followup. All implants were in place in the surviving patients. The mean HHS improved from 36 preoperatively to 80 at latest followup. There were no reoperations for any reason, and we observed no implant loosening or migration at final followup in surviving or deceased patients. Tantalum trabecular metal acetabular components restored function and provided durable reconstruction in patients undergoing THA following prior pelvic radiation. We observed no clinical or radiographic failures at a minimum 5-year followup. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 05/2012; 470(11):3041-7. · 2.79 Impact Factor
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    ABSTRACT: Phosphaturic mesenchymal tumor of mixed connective tissue type is a rare, histologically distinctive mesenchymal neoplasm associated with tumor-induced osteomalacia resulting from production of the phosphaturic hormone fibroblast growth factor 23. Because of its rarity, specific genetic alterations that contribute to the pathogenesis of these tumors have yet to be elucidated. Herein, we report the abnormal karyotypes from 2 cases of confirmed phosphaturic mesenchymal tumor of mixed connective tissue type. G-banded analysis demonstrated the first tumor to have a karyotype of 46,Y,t(X;3;14)(q13;p25;q21)[15]/46XY[5], and the second tumor to have a karyotype of 46, XY,add(2)(q31),add(4)(q31.1)[2]/92,slx2[3]/46,sl,der(2)t(2;4)(q14.2;p14),der(4)t(2;4)(q14.2;p14),add(4)(q31.1)[10]/46,sdl,add(13)(q34)[4]/92,sdl2x2[1]. These represent what is, to our knowledge, the first examples of abnormal karyotypes obtained from phosphaturic mesenchymal tumor of mixed connective tissue type.
    Human pathology 04/2012; 43(8):1334-8. · 3.03 Impact Factor
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    ABSTRACT: Large bone loss and frequently irradiated existing bone make reconstructing metastatic and other nonprimary periacetabular tumors challenging. Although existing methods are initially successful, they may fail with time. Given the low failure rates of porous tantalum acetabular implants in other conditions with large bone loss or irradiated bone, we developed a technique to use these implants in these neoplastic cases where others might fail. After local tumor curettage, a large uncemented tantalum shell (sometimes with tantalum augments) was fixed to remaining bone using numerous screws. When substantial medial bone loss was present, an antiprotrusio cage was placed over the top of the cup and secured to remaining ilium and ischium. We retrospectively reviewed 20 patients who underwent THAs for neoplastic bone destruction with the described technique. Their mean age was 60 years (range, 22-80 years). We recorded pain and ambulatory status, pain medication use, and Harris hip scores. We assessed for progressive radiolucent lines and component migration on followup radiographs. Eleven of the 20 patients died at a mean of 17 months after surgery. The minimum followup for surviving patients was 26 months (mean, 56 months; range, 26-85 months). Harris hip scores improved from a mean 32 preoperatively to a mean 74 postoperatively. We observed no cases of progressive radiolucent lines or component migration. Complications included one perioperative death, two superficial infections, one deep vein thrombosis, and one dislocation. Our initial experience has made tantalum reconstruction our preferred method for dealing with major periacetabular neoplastic bone loss. Additional studies comparing this technique with alternatives are required. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 02/2012; 470(2):594-601. · 2.79 Impact Factor
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    ABSTRACT: BackgroundMalignant pelvic tumors frequently pose challenges to surgeons owing to complex pelvic anatomy and local extension. External hemipelvectomy frequently allows adequate margins but is associated with substantial morbidity and reduced function. Limb salvage is an alternative approach when adequate margins can be achieved, but long-term function and survival are unclear. Questions/purposesWe therefore determined the long-term survival; development of late local recurrence and metastases; function; and need for further reconstructive procedures for patients undergoing limb salvage for treatment of malignant pelvic tumors. Patients and MethodsWe retrospectively reviewed 60 patients treated with pelvic limb salvage before 1989. We reviewed medical records and sent questionnaires incorporating Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage scores to the 38 patients who had no evidence of disease in 1989; 15 patients responded. Minimum followup was 23years (median, 30years; range, 23–38years). ResultsOverall survival rate of the 60 patients was 45%: 100% Stage IA, 75% Stage IB, 31% Stage IIB, and 0% Stage III were alive. Late local recurrence developed only in patients with chondrosarcoma (three of 24). Two patients developed late distant bone metastases. Function declined: the MSTS score of the 15 patients who completed a questionnaire decreased 23%. Two patients had further reconstructive procedures. ConclusionsAt 23- to 38-year followup, we believe pelvic limb salvage is a reasonable treatment if satisfactory margins can be achieved. If a patient with pelvic sarcoma is free of disease 5years after sarcoma resection, the subsequent risk of death from sarcoma appears to be low. Late local recurrence remains a risk in patients with pelvic chondrosarcoma. Patient-reported function of the salvaged limb declined with long-term followup. Level of EvidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 01/2012; 470(3):712-727. · 2.79 Impact Factor
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    ABSTRACT: Multicentric osteosarcoma (M-OGS) is characterized by multicentricity of osseous osteosarcomas, either synchronous or metachronous, without visceral involvement. The study's purpose was to clinicopathologically and radiographically analyze 56 cases of M-OGS (22 synchronous and 34 metachronous). The distal femur was the most common site. Histologically, all tumors were high grade. Of 22 patients with synchronous M-OGS, 16 had 3 or more simultaneous tumors; the axial skeleton was involved in 14 (64%) of 22 cases. In metachronous M-OGS, the second malignancy occurred after a median of 22 months. Treatment was surgery, chemotherapy, radiotherapy, or a combination of these. Patients with metachronous osteosarcoma had a median survival longer than did patients with synchronous tumors. Overall, 8 long-term survivors were treated by aggressive surgery with wide margins (plus chemotherapy and/or radiotherapy). M-OGS combines multiple skeletal locations of high-grade conventional osteosarcomas and has a poor prognosis. Aggressive surgery may result in improved long-term survival, particularly in patients with metachronous disease.
    American Journal of Clinical Pathology 11/2011; 136(5):799-807. · 2.88 Impact Factor
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    ABSTRACT: Sacrectomy positioning must balance surgical exposure, localization, associated operative procedures, and patient safety. Poor positioning may increase hemorrhage, risk of blindness, and skin breakdown. The authors prospectively identified positioning-related morbidity in 17 patients undergoing 19 prone sacral procedures from September 2008 to August 2009 following institution of a standardized positioning protocol. Key elements include skull traction/head suspension, an open radiolucent frame, and wide draping for associated closure and reconstructive procedures. Tumors included 5 chordomas, 4 high-grade sarcomas, 1 chondrosarcoma, 2 presacral extradural myxopapillary ependymomas, and 5 others. Mean patient age was 49.9 years (range 17-74 years); mean body mass index was 27.6 kg/m(2) (range 19.3-43.9 kg/m(2)). Mean preoperative Braden skin integrity score was 21.1 (range 17-23). Average operative time was 501 minutes (range 158-1136 minutes). Prone surgery was a part of staged anterior/posterior resections in 8 patients. Localization was conducted using fluoroscopy in 13 patients and intraoperative CT in 4 patients. All imaging studies were successful. One patient developed a transient ulnar nerve palsy attributed to positioning. Three patients (two of whom were morbidly obese) developed Stage I pressure injuries to the chest and another developed Stage II pressure injury following a 1136-minute procedure. Morbidity was only observed in patients with morbid obesity or with procedures lasting in excess of 10 hours. A positioning protocol using head suspension on an open radiolucent frame facilitates oncological sacral surgery with reasonable patient morbidity. Morbid obesity and procedure times in excess of 10 hours are risk factors for positioning-related complications. To the authors' knowledge, this is the first report of surgical positioning morbidity in this patient population.
    Journal of neurosurgery. Spine 09/2011; 16(1):51-6. · 1.61 Impact Factor
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    ABSTRACT: Approximately 50% of patients with aneurysmal bone cyst of the spine are in the pediatric age group. Aneurysmal bone cyst is considered a locally aggressive benign tumor that may involve the posterior and anterior elements of the spine. Intralesional extended curettage and bone-grafting is the mainstay of treatment of aneurysmal bone cysts involving the long bones. However, the proximity to neurovascular structures and the potential remaining growth of the spine make its management in the spine more challenging. We evaluated the clinical presentation and the results of surgical treatment, following complete intralesional curettage along with spinal arthrodesis in pediatric patients with aneurysmal bone cysts of the cervical spine. We retrospectively reviewed the cases of seven children who were surgically treated for a primary aneurysmal bone cyst of the cervical spine between 1988 and 2008. There were four boys and three girls who had a mean age of 11.9 years (range, eight to 16.2 years) at the time of diagnosis. The mean duration of follow-up was 46.5 months (range, twenty-six to ninety-eight months). The mean age at the time of follow-up was sixteen years (range, 10.6 to 24.6 years). Neck pain was the most common presenting symptom, and radiculopathy was the most common finding on physical examination. Radiographs, computed tomography, and magnetic resonance imaging were highly suggestive for the diagnosis that was confirmed histologically in all patients. The majority (four) of the patients required combined anterior and posterior approaches for complete removal of the tumor and arthrodesis of the spine. Two patients required additional procedures: one for a local recurrence and one for nonunion of the atlantooccipital junction. All patients were free of evidence of recurrent disease at the time of the last follow-up. With the exception of one patient who had permanent Horner syndrome, all patients were asymptomatic. Preoperative arterial embolization, complete tumor excision by intralesional curettage and burring, followed by local spinal fusion, yield satisfactory results with a low rate of complications and low recurrence in children with an aneurysmal bone cyst of the cervical spine.
    The Journal of Bone and Joint Surgery 08/2011; 93(16):1534-43. · 3.23 Impact Factor
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    ABSTRACT: Currently, no data from randomized controlled clinical trials are available to guide the depth of resection for intermediate-thickness primary cutaneous melanoma. Thus, we hypothesized that substantial variability exists in this aspect of surgical care. We have summarized the literature regarding depth of resection and report the results of our survey of surgeons who treat melanoma. Most of the 320 respondents resected down to, but did not include, the muscular fascia (extremity, 71%; trunk, 66%; and head and neck, 62%). However, significant variation exists. We identified variability in our own practice and have elected to standardize this common aspect of routine surgical care across our institution. In light of the lack of evidence to support resection of the deep muscular fascia, we have elected to preserve the muscular fascia as a matter of routine, except when a deep primary melanoma or thin subcutaneous tissue dictates otherwise.
    Mayo Clinic Proceedings 06/2011; 86(6):522-8. · 5.79 Impact Factor
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    ABSTRACT: Treatment of giant cell tumor of bone (GCT) often is complicated by local recurrence. Intralesional curettage is the standard of care for primary GCTs. However, there is controversy whether intralesional curettage should be preferred over wide resection in recurrent GCTs. We investigated the rerecurrence-free survival after surgical treatment of recurrent GCTs to determine the influence of the surgical approach, adjuvant treatment, local tumor presentation, and demographic factors on the risk of further recurrence. We retrospectively reviewed the medical records of 46 patients with recurrent GCTs of long bones treated with wide resection or intralesional curettage and compared these cohorts. Recurrence rates, risk factors for recurrence, and the development of pulmonary metastases were determined. The minimum followup was 37 months (mean, 134 months; range, 37-337 months). The rate of rerecurrence after wide resection was 6%. Intralesional curettage showed an overall rerecurrence rate of 32%. Implantation of polymethylmethacrylate (PMMA) instead of bone grafting was associated with a lower risk of subsequent recurrence in intralesional procedures (14% versus 50%). Extracompartmental disease did not increase the risk of rerecurrence. Pulmonary metastases occurred in seven patients and appeared independent of the surgical treatment modality chosen. Intralesional curettage with methylmethacrylate for recurrent GCT provided equivalent tumor control compared with resection in this retrospective study. If joint salvage is possible, we advocate this treatment over resection in recurrent GCTs to preserve the native joint articulation. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 04/2011; 469(4):1181-7. · 2.79 Impact Factor
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    ABSTRACT: Many surgeons treat giant cell tumor of bone (GCT) with intralesional curettage. Wide resection is reserved for extensive bone destruction where joint preservation is impossible or when expendable sites (eg, fibular head) are affected. Adjuvants such as polymethylmethacrylate and phenol have been recommended to reduce the risk of local recurrence after intralesional surgery. However, the best treatment of these tumors and risk factors for recurrence remain controversial. We evaluated the recurrence-free survival after surgical treatment of GCT to determine the influence of the surgical approach, adjuvant treatment, local tumor presentation, and demographic factors on the risk of recurrence. We retrospectively reviewed 118 patients treated for benign GCT of bone between 1985 and 2005. Recurrence rates, risk factors for recurrence and the development of pulmonary metastases were determined. The minimum followup was 36 months (mean, 108.4 ± 43.7; range, 36-233 months). Wide resection had a lower recurrence rate than intralesional surgery (5% versus 25%). Application of polymethylmethacrylate decreased the risk of local recurrence after intralesional surgery compared with bone grafting; phenol application alone had no effect on the risk of recurrence. Pulmonary metastases occurred in 4%; multidisciplinary treatment including wedge resection, chemotherapy, and radiotherapy achieved disease-free survival or stable disease in all of these patients. We recommend intralesional surgery with polymethylmethacrylate for the majority of primary GCTs. Because pulmonary metastases are rare and aggressive treatment of pulmonary metastases is usually successful, we believe the potential for metastases should not by itself create an indication for wide resection of primary tumors. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 02/2011; 469(2):591-9. · 2.79 Impact Factor
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    ABSTRACT: Locally recurrent rectal cancer involving the upper sacrum is generally considered a contra-indication to curative surgery. The aim of this study was to determine if a survival benefit was seen in patients undergoing high sacrectomy. All patients with locally recurrent rectal cancer involving the sacrum above the 3rd sacral body between 1999 and 2007 were retrospectively reviewed. Kaplan-Meier survival analysis was performed. Nine patients were identified with a median age of 63 years. The proximal extent of sacral resection was through S2 (n = 6), S1 (n = 2), and L5-S1 (n = 1). All patients had R0 negative-margin resection. Median operative time was 13.7 hr, and median operative blood transfusion was 3.7 L. Thirty-day mortality was nil. Postoperative complications requiring surgical intervention occurred in three patients. Local re-recurrence in the pelvis occurred in one patient. The overall median survival was 31 months (range, 2-39 months). Three patients still alive are free of disease after 40, 76, and 101 months, respectively. Ultimately, all deaths were due to metastatic disease. High sacrectomy that achieves clear margins in patients with recurrent rectal cancer is safe and feasible. A majority will die of metastatic disease, but long-term survival may be possible in some patients.
    Journal of Surgical Oncology 02/2011; 103(2):105-9. · 2.64 Impact Factor
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    ABSTRACT: Desmoid tumors are a rare group of locally aggressive, non malignant tumors of fibroblastic origin that can lead to significant morbidity due to local invasion. Despite advances in the understanding of these tumors, their natural history is incompletely understood and the optimal treatment is still a matter of debate. Local control is the main goal of treatment and there has been a change in philosophy regarding the management of these tumors from aggressive surgical resection to function preservation. A multidisciplinary approach is essential to plan local control with acceptable morbidity. The current Mayo Clinic algorithm for the treatment of these tumors is based on institutional experience and the available evidence in the literature: asymptomatic/non progressive lesions away from vital structures are managed with observation and regular imaging; primary or recurrent desmoid tumors which are symptomatic or progressive or near vital structures are managed with wide surgical resection when wide surgical margins are possible with minimal functional and cosmetic loss. When positive or close surgical margins are likely, surgical resection with adjuvant radiotherapy or definitive radiotherapy is preferred. If likely functional or cosmetic deficit is unacceptable, radiotherapy is the treatment of choice. Unresectable lesions are considered for radiotherapy, chemotherapy or newer modalities however an unresectable lesion associated with a painful, functionless, infected extremity is managed with an amputation.
    Cancers. 01/2011; 3(3):3143-55.
  • Journal of Bone and Joint Surgery - British Volume 01/2011; 93(SUPP II):198-198. · 2.69 Impact Factor
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    ABSTRACT: Retrorectal sarcomas are rare, and limited data are available on oncologic outcomes following surgery. Our aim was to evaluate outcomes in this patient population at our institution. All patients who underwent surgical resection of a malignant retrorectal/presacral sarcoma between 1985 and 2005 were identified. Data analyzed included demographics, histopathologic diagnosis, surgical morbidity and mortality, use of adjuvant therapy, local and distant recurrence, and survival. A total of 37 patients were identified (20 males) with a median age of 49 years (range, 22-81 years). The most common histopathologic diagnosis was malignant peripheral nerve sheath tumor (n = 8). Also, 22 tumors were high grade and 15 were low grade. Surgical margin status was R0 in 31 patients and R1 in 6. Adjuvant therapy was given to 26 patients. Postoperative morbidity and mortality was 57% and 3%, respectively. Median length of follow-up in 16 patients alive at last contact was 4.7 years. The 5-year survival free of local (LDFS), distant (DDFS), and local or distant recurrence (DFS) was 51, 58, and 39%, respectively. Patient survival at 2, 5, and 10 years was 75, 55, and 47%, respectively. Disease-free survival was not significantly associated with gender (P = .16), primary vs secondary (P = .94), R0 vs R1 resection (P = .26), low vs high tumor grade (P = .17), or the use of surgery with or without adjuvant therapy (P = .33). Retrorectal sarcomas are often high grade and locally advanced. Most tumors are resectable with free margins, and long-term survival may be possible in up to one-half of patients following an aggressive surgical approach.
    Annals of Surgical Oncology 12/2010; 18(4):983-8. · 4.12 Impact Factor

Publication Stats

6k Citations
852.07 Total Impact Points


  • 1985–2012
    • Mayo Foundation for Medical Education and Research
      • • Department of Orthopaedic Surgery
      • • Department of Radiology
      • • Department of Orthopedics
      • • Department of Diagnostic Radiology
      Scottsdale, AZ, United States
  • 1976–2012
    • Mayo Clinic - Rochester
      • • Division of Orthopaedic Surgery
      • • Department of Orthopedics
      Rochester, Minnesota, United States
  • 2011
    • University of Colorado
      Denver, Colorado, United States
  • 2010
    • Attikon University Hospital
      Athínai, Attica, Greece
  • 2009
    • Semmelweis University, Budapest
      • Department of Orthopaedics
      Budapest, Budapest fovaros, Hungary
  • 2008
    • Uniklinik Balgrist
      Zürich, Zurich, Switzerland
    • University of Zurich
      • Department of Pediatric Orthopaedics
      Zürich, ZH, Switzerland
  • 2002–2008
    • State University of New York Upstate Medical University
      • Department of Orthopedic Surgery
      Syracuse, New York, United States
  • 1995–2008
    • Johns Hopkins University
      • Department of Orthopaedic Surgery
      Baltimore, MD, United States
  • 2007
    • Thomas Jefferson University
      Philadelphia, Pennsylvania, United States
    • Chiang Mai University
      • Department of Orthopedics
      Chiang Mai, Chiang Mai Province, Thailand
  • 2004–2007
    • Rothman Institute
      Philadelphia, Pennsylvania, United States
    • China Medical University Hospital
      臺中市, Taiwan, Taiwan
  • 2003–2007
    • National and Kapodistrian University of Athens
      • Division of Orthopaedics - Traumatology I
      Athens, Attiki, Greece
    • Alexandria University
      Al Iskandarīyah, Alexandria, Egypt
  • 2000–2001
    • University of Texas MD Anderson Cancer Center
      Houston, Texas, United States
    • Yeungnam University
      Onyang, South Chungcheong, South Korea
  • 1999
    • Niigata University
      • Division of Orthopedic Surgery
      Niahi-niigata, Niigata, Japan
    • University of Vienna
      Wien, Vienna, Austria
  • 1998–1999
    • Chang Gung Memorial Hospital
      • Department of Orthopaedic Surgery
      T’ai-pei, Taipei, Taiwan
  • 1996–1997
    • State University of New York
      New York City, New York, United States
  • 1986
    • KU Leuven
      • Department of Reproduction, Development and Regeneration
      Leuven, VLG, Belgium
  • 1982
    • University of Minnesota Rochester
      Rochester, Minnesota, United States
  • 1978
    • Comprehensive Cancer Centers of Nevada
      Las Vegas, Nevada, United States