Our Treatments｜Features of the Department｜Doctors and Staff
Our Treatments
The Department of Orthopedic Oncology provides diagnosis and treatment of tumors that occur in the limbs and trunk (such as chest wall, abdominal wall, pelvis and spine), and the musculoskeletal system (such as muscle).
Treatment Policies
Complete Tumor Resection
The basis of our treatment is to completely control the primary tumor. Malignant tumors have to be resected with an enough margin of normal tumor-free tissue. If normal tissue is resected more extensively, the recurrence rate will decrease. However, the more we resect the tissue, the poorer postoperative function the patient will have. We have conducted a long-term study of the resected area and the postoperative condition in many patients. As a result, we established the concept of “safe surgical margin”, and surgery according to this guideline led to a decrease in the number of limb amputation. In addition, for patients to whom it is difficult to ensure safe surgical margins and who cannot consent to amputation, we try to satisfy their requests by providing radiotherapy or other treatments. In 2014, we introduced a Navigation System, in which the latest image processing system is applied, to resect tumors precisely and to obtain better postoperative function.
Reconstruction for Better Function of the Affected Limbs
For limb salvage, various reconstructive operations are needed after tumor resection. Before surgery, we ask all the patients to select the preferable treatment by themselves after they fully understand the advantages and disadvantages of each reconstructive operation.
We provide several reconstructive operations, including:
- Joint replacement
- Reconstruction of vessels
- Muscle flap transfer (including microsurgery)
- Joint replacement with an expandable prosthesis in children
- Limb lengthening with external fixators
- Bone reconstruction with pasteurized bone, which was developed in our department
- Bone/vascular/nerve preservation using intraoperative evaluation of surgical margins (ISP), which is our original procedure
In patients for whom preoperative imaging shows that nerves or blood vessels are adjacent to the sarcoma, ISP (In situ preparation) enables to confirm whether or not preservation is possible without the risk of tumor transplantation during surgery. As a result, it also enables to prevent the meaningless sacrifice of nerves or blood vessels.
Even if amputation is inevitable, rotationplasty and turn-up procedures, which allow surgeons to obtain a longer amputation stump than normal amputation, are available.
Features of the Department
Medical Care System
For the quick and proper transition from the diagnosis to the treatment of musculoskeletal tumors, all staff members of our department are involved in all steps from the diagnostic imaging to the treatment. Treatment plan is determined in the Cancer Board conference (organ-specific conferences among many doctors in different specialties). Before surgery, explanation to the patient is given on the operative procedure by the doctor in charge. After surgery, tumor specimens are carefully examined and analyzed.
Accurate and Rapid Diagnosis
For a patient with a possibility of cancer, medical procedures are different between bone and soft tissue tumors.
In the case of bone tumors, radiography is performed and whether the tumor is benign or malignant is predicted based on the image. If the patient is suspected to have a malignant tumor or a benign tumor for which he/she needs surgery, additional examinations (such as CT and MRI) will be performed as necessary. In emergency cases, various examinations are performed within one week for the preparation of inpatient treatment.
In the case of soft tissue tumors, radiography (soft-tissue radiography) and ultrasonography are performed at the first visit, immediately followed by needle biopsy for cytological and pathological diagnosis. Rapid cytology enables to determine whether the tumor is benign or malignant on the day of examination in more than 90% of patients. If the patient has a malignant tumor, CT, MRI or other exams will be performed within one week to start the treatment, same as the bone tumor cases. This system allowing such prompt diagnosis and treatment can be found no other hospitals in the world.
Cancer Board
Orthopedists, plastic surgeons and radiation oncologists have meetings twice a week to determine the extent of resection and the reconstruction method based on preoperative imaging and biopsy diagnosis. We also compare surgical specimens and preoperative images in detail to discuss whether the existence of the tumor was confirmed as estimated preoperatively, whether the reconstruction method was suitable, and so on. These discussions serve as basic data for improving treatment.
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