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Saving a Limb, Saving a Life: Complex Tumor Surgery Restores 68-Year-Old’s Mobility

When cancer spreads to the bones, patients often face a devastating choice: amputation or risking their life. But advanced surgical techniques are changing that equation. A 68-year-old patient recently underwent groundbreaking limb salvage surgery at Burjeel Medical City, proving that expertise and technology can offer hope where others see no option. 

The Challenge 

The patient, a known case of Renal Cell Carcinoma who had previously undergone nephrectomy and chemotherapy, began experiencing pain in his left leg three months prior. The pain gradually intensified until, one month before seeking treatment, he could no longer bear weight on the leg. 

Initial investigations revealed alarming findings: 

• Large osteolytic lesion of the left proximal tibia 

• Crack fracture at the lesion site 

• Fine needle biopsy confirmed: Renal Cell Carcinoma metastatic to bone 

The case was discussed in a Multidisciplinary Team (MDT) meeting, where the consensus was clear: surgical treatment with possible adjuvant radiation therapy offered the best chance for quality of life. 

The Surgical Solution: Limb Salvage with Tumor Prosthesis 

The surgical plan was ambitious: 

1. Radical resection of left proximal tibia 

2. Limb salvage surgery using proximal tibia hinged tumor prosthesis 

3. Rotational muscle flap to cover the prosthesis 

The Complex Procedure 

The surgery was performed under combined spinal and epidural anesthesia with sedation. The patient was positioned supine on an orthopedic table with a tourniquet applied to the left thigh. 

Surgical steps included: 

• Meticulous dissection from proximal to distal 

• Arthrotomy with release of collateral ligaments, ACL, PCL, and menisci 

• Precise measurement: 190mm segment marked for resection 

• Complete removal of the affected proximal left tibia segment 

The Critical Moment: Frozen Section Analysis 

Four frozen sections were taken to ensure complete tumor removal: 

• Distal intramedullary margin 

• Medial margin 

• Lateral margin 

• The bed (posterior margin) 

After 25 minutes, the results returned: all margins negative for malignant cells—the outcome every surgeon and patient hopes for. 

Reconstruction and Recovery 

With clear margins confirmed, the team proceeded with: 

• Femoral component preparation 

• Tibial component fitting 

• Trial assembly to check stability and alignment 

• Final implant assembly and application 

• Rotational muscle flaps to cover the prosthesis 

• Reattachment of patellar tendons to the prosthesis attachment tube 

The procedure achieved minimal blood loss, and no intraoperative or postoperative blood transfusions were needed. Total blood loss: just 50ml. 

Understanding Metastatic Bone Disease 

When cancer spreads to bones, it can cause: 

• Severe pain 

• Pathological fractures 

• Loss of mobility 

• Significant reduction in quality of life 

Traditional treatment often meant amputation. Modern limb salvage surgery offers an alternative, preserving function while removing the tumor. 

The Technology Behind Success 

This complex procedure was possible due to: 

• Advanced Tumor Prosthetics: Custom-designed implants that replace removed bone 

• Frozen Section Laboratory: Real-time pathology analysis during surgery 

• Multidisciplinary Approach: Orthopedic oncology, anesthesia, pathology, and oncology working together 

• Modern Surgical Techniques: Minimizing blood loss and tissue trauma 

Post-Operative Outcome 

Final Pathology: Moderately differentiated esophageal adenocarcinoma, stage pT1bN0 (all 32 lymph nodes negative for metastases) with negative resection margins (R0 resection). 

Post-Operative Management: The Oncology MDT meeting determined that follow-up only was required—no adjuvant chemoradiotherapy needed. 

The patient’s recovery was unremarkable, and he remained well at his 6-week follow-up appointment. 

Why Choose Burjeel for Complex Orthopedic Oncology 

• Specialized orthopedic oncology team 

• State-of-the-art frozen section laboratory 

• Access to advanced tumor prosthetics 

• Multidisciplinary tumor board 

• Comprehensive cancer care pathway 

• Rehabilitation and physiotherapy programs 

Our Experts 

Advanced Orthopedic Oncology Care 

Complex bone tumors require specialized expertise. Our multidisciplinary team provides comprehensive evaluation and treatment options, including limb salvage surgery when possible. 

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