A 19-year-old male patient with a giant bone tumor the size of a 9-month-old fetus was successfully treated by multidisciplinary surgery, via a team of more than 30 doctors and nurses specializing in Orthopedics, Gastroenterology – Urology, Cardiology, Anesthesiology, Resuscitation, etc., of Vinmec Times City International Hospital.
With an osteocartilaginous tumor weighing over 2kg and located in a rare and extremely exceedingly complicated area, the patient is always at risk of death during surgery. In advanced countries, similar surgeries can only be performed, with low success rates, in a few Sarcoma centers (Sarcoma – a form of cancer in connective tissue).
Patient D.N.H.T (19 years old) was diagnosed with a rare huge tumor (over 20cm), located in the pelvic floor, by the doctors at the Center for Orthopedics and Sports Medicine, Vinmec. It is estimated that only 5 – 10 similar cases are detected in Vietnam each year, accounting for about 5% of bone cancer cases. Earlier, the patient showed signs of numbness in the pelvic area, limiting his range of motion and abnormal gait. He visited many medical facilities, which all diagnosed him with mild soft-tissue injuries due to playing sports even though the tumor had protrude outward, compressing the pelvic organs, and causing edema and surrounding muscle atrophy.
The patient is immediately consulted by the Tumor Board, whose members are foreign experts and leading domestic professors and doctors in surgery, radiotherapy, chemistry, diagnosis imaging, pathology, psychology, nutrition, etc. The Tumor Board decided to perform a radical surgery and considered adjuvant treatment afterward.
In this case, the patient has the risk of death on the table as the tumor is supplied by a large and complex vascular system, resulting in the possible loss of up to 10 liters of blood. On the other hand, the tumor’s compression on vital organs such as the digestive system, urinary system, spine, pelvis, and blood vessels is a challenge to approach. In the case of hemorrhage, it would lead to an uncontrollable situation without clearly revealing the tumor and related parts. However, without surgery, the patient would face the risk of left leg muscle atrophy, directly threatening his life.
Prof. Ph.D. Dr. Tran Trung Dung – Director of the Center for Orthopedics and Sports Medicine, Vinmec Times City International Hospital said: “The giant bone tumor in the pelvis (like a pregnant woman) has compressed the left sciatic nerve, causing numbness and left leg atrophy. Untimely treatment leads to loss of function in the left leg, and is even life-threatening. Due to the increased size of the tumor, it would compress and cause blockage in the digestive or urinary system. Therefore, it is necessary to remove early to help restore limb function and avoid distant complications of the digestive and urinary systems”.
After the determination, the Tumor Board of surgical specialties – Vinmec Times City International Hospital – made a meticulous surgical plan forthwith with the participation of doctors in specialties, in which the leading doctors are the Director/Head of the Department: Orthopedics (Prof. Ph.D. Dr. Tran Trung Dung, MMed. Specialist level II Nguyen Tran Quang Sang, Specialist level II Pham Trung Hieu), Gastroenterology (Assoc. Prof. Dr. Pham Duc Huan), Urology (Prof. Dr. Vu Ngoc Thang), Cardiology (Prof. Dr. Vu Anh Dung), Anesthesiology (MMed. Dr. Vu Tuan Viet), Diagnostic Imaging (MMed. Dr. Nguyen Van Phan), etc.
Specifically, a day before the surgery, the radiologists embolized large blood vessels of the tumor to minimize blood loss during surgery. The next day, cardiologists, gastroenterologists, and urologists participated in the initial phase of surgery. Cardiologists exposed and controlled the iliac artery, and may perform ligation when bleeding is severe. The urologist then released the bladder and ureters from the tumor, and the gastroenterologist performed a dissection to protect the digestive tract.
After that, orthopedic experts removed the tumor through two incisions in the abdomen and behind the thigh. During the major surgery, the team of anesthesiologists continuously monitored and adjusted to maintain a stable state and minimize post-operative complications simultaneously. The surgical team of more than 30 doctors, nurses, and technicians worked tirelessly to aim for the patient’s recovery.
3D Technology in Medicine Center (VinUni) has highly contributed to the success of the “historic” major surgery. The tumor model is printed on a 1:1 scale using 3D technology and, consequently, gives a visual and accurate assessment of shape, volume, and correlation with vital organs. Based on that, doctors can reasonably plan the operative approach and minimize complications.
Currently, there are only a few large centers in the world applying 3D printing technology to disease models for preoperative planning of complex cases. Vinmec is the first and only unit to carry this technology in Vietnam. Presently, 100% of bone, joint, and cancer surgeries at Vinmec are performed in the same process: a virtual surgery (on the software), an experimental surgery (on the model), and then an actual surgery (on the patient).
The major surgery lasted 8 hours and was successful as expected. After three days, the patient regained consciousness and returned to normal activities. After a quick recovery, the patient was discharged on September 20th, 2023, only one week after the major surgery. The wait for the pathology results is necessary to consider radiotherapy, but it is only an additional method. In this case, successful surgery is the best treatment.
“It is a long and extremely complex major surgery, requiring the smooth multidisciplinary coordination of experienced and highly specialized doctors. In this rare case, there are only a few specialist centers in the world that can perform surgery. In Vietnam, there are very few hospitals that can prepare human resources, equipment, and an early post-operative recovery program to help patients be discharged after just one week”, said Assoc. Prof. Dr. Pham Duc Huan, Director of the Center for Gastroenterology – Hepatobiliary – Urology, Vinmec Times City International Hospital.
Bone cancers are rare malignant tumors originating in bone and derived from primitive mesenchymal cells. Although it is a rare disease, accounting for only < 1% of all cancers, it mainly affects children, adolescents, and young adults in the 10–20 age group, often during a growth spurt. The cause of osteosarcoma is unknown. It often develops slowly, with vague and unclear symptoms in the early stages, making it difficult to detect without proactive screening at specialized medical facilities. In the case of the male student in the article, he visited many doctors but no disease was found since it was a cartilaginous tumor, which is difficult to detect with conventional X-rays. With just 200 new bone cancer patients diagnosed in Vietnam each year, it is understandable that doctors may make a misdiagnosis.
Proud to be a leader in bone cancer prevention and treatment, the Center for Orthopedics and Sports Medicine will continue its mission of raising public awareness and understanding of bone tumors, and applying advanced technology and exclusive limb-salvage methods to bring a bright new life for future generations. Bone cancer is malignant but can be screened and treated effectively if parents have scientific knowledge and regularly take their children for health checks and early detections.
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