December 08, 2008
News Office: Lauren Hammit (415) 502-6397
A UCSF surgical team successfully removed a large cancerous tumor in a single piece from the cervical spine of a patient in 12 hours — a procedure that is believed to be the first of its kind in complexity and to have taken place in record time.
Most important, the procedure provides the patient with the possibility of total elimination of the cancer.
Called an en bloc resection, the procedure takes its name from the removal of tissue as a whole (en bloc), rather than piecemeal. The seven-inch tumor spanned four neck vertebrae — C3, C4, C5 and C6 — and was removed by a team of two UCSF surgical specialists.
In peer-reviewed medical literature, there are reports of two patient cases of tumor removal involving three cervical vertebrae, and these procedures each took approximately 40 hours. In a medical journal in the future, the UCSF team plans to report its experience in performing the four-vertebrae procedure.
An en bloc resection is technically challenging, according to the UCSF team, but for certain types of tumors, it provides the patient with the only real chance at a cure. In the past, these tumors were removed in pieces, which left significant tumor tissue and led to recurrence. En bloc resection patients have a better chance at eradication of the cancer, the medical team said.
"The short operation time and successful outcome are the result of a willing patient, a professional medical team and a multidisciplinary approach between neuro- and orthopedic surgery," said UCSF neurosurgeon Dr. Christopher Ames, director of spinal tumor and deformity surgery, Department of Neurological Surgery, who performed the surgery along with Dr. Vedat Deviren, Department of Orthopaedic Surgery.
The UCSF Spine Center is the only center on the West Coast that routinely performs extremely complex procedures that involve the spine. Per year, the center performs from 10 to 15 en bloc resections and treats about 300 patients, who have come to UCSF from around the world.
Their medical problems include spinal deformity, degenerative diseases of the spine, herniated discs, lumbar vertebral displacement (spondylolisthesis), spinal tumors, acute fractures and trauma to the spine, infections, neck and low-back disorders, osteoarthritis and rheumatoid arthritis affecting the cervical, thoracic and lumbar spine.
"We have been treating extremely complex cases with minimal morbidity," said Deviren, associate professor in clinical orthopedics at UCSF. "The four-vertebrae en bloc procedure is just one of the tremendously complex surgeries that we performed over the year. I am very pleased with our multidisciplinary approaches and results."
The patient who underwent the en bloc procedure, Mary Shorba, 60, of Mendocino County, had the surgery four months ago to remove a chordoma, a usually rare, malignant, slow-growing tumor of the spine. Shorba learned of the tumor just days before the procedure took place.
"Prior to the surgery, the only symptom I experienced was discomfort during my morning walks and periodic neck pain that became progressive," Shorba said. "Now, I feel hopeful for complete recovery and grateful to be where I am."
All of the cancerous tissue appears to have been removed, according to the medical team, and Shorba will undergo regular checkups in the future to determine whether there is a recurrence.
The surgery took place in two stages, anterior and posterior, taking nearly six hours apiece. In addition to tumor removal, the procedure included reconstruction and stabilization of the spine. After the tumor was removed, surgeons immediately rebuilt the spine with cages, screws and rods.
"Because of the proximity to sensitive anatomy including the spinal cord, pharynx, nerves and major blood vessels — along with the need to remove the entire tumor as a single piece to prevent spreading cancerous cells — many surgeons are not able to operate for fear of causing irreversible nerve damage," Ames said.
Cervical chordomas are challenging lesions to approach surgically, according to the medical team. Some tumors span several vertebrae that, with time, can press against the spinal cord and cause pain, numbness and loss of mobility in the hands, arms and legs. If left untreated, patients can become paralyzed.
The strength of the UCSF Spine Center is its team of specialists that includes orthopedic surgeons, neurosurgeons, neurologists, cancer specialists, physiatrists (who specialize in rehabilitation and non-operative care of spinal disorders), radiologists, rheumatologists (arthritis specialists), nurses, physical therapists, pain specialists and complementary medicine specialists.