AUTHOR=Cariboni Umberto , Gennaro Nicolò , Costa Francesco , Renne Salvatore Lorenzo , Novellis Pierluigi , Marrari Andrea , Bertuzzi Alexia Francesca , Civilini Efrem 

TITLE=Multi-Step Combined Upfront Surgery for Locally Advanced Paravertebral Sarcoma: A Case Report

JOURNAL=Frontiers in Surgery

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2021.664089

DOI=10.3389/fsurg.2021.664089

ISSN=2296-875X

ABSTRACT=<p><bold>Background:</bold> Paravertebral localization of primary undifferentiated pleomorphic sarcoma (UPS) with bone and vascular involvement is infrequent and challenging. Multi-step surgical procedure has been described as a feasible and effective option to achieve sustained local tumor control.</p><p><bold>Methods:</bold> We report on a 62-year old man with paravertebral UPS infiltrating the aortic wall and the 9th thoracic vertebra who underwent a multi-step surgical procedure aimed at achieving oncologic radicality through a coordinated effort between thoracic, vascular and spinal surgeons. After balancing the risks and benefits of perioperative therapies, upfront surgery was performed including aortic resection with bypass grafting followed by a triple <italic>en bloc</italic> vertebrectomy with tumor excision. Mid-term follow-up (22 months) is then provided.</p><p><bold>Results:</bold> The combined procedure achieved oncological radicality and no local recurrence in the mid-term. No major complications occurred.</p><p><bold>Conclusions:</bold> Multi-step and multi-specialty surgery is a feasible and effective strategy to treat primary UPS in unfavorable localization. A strategic cooperation between surgeons and a multidisciplinary tumor board is required to define an optimal, personalized treatment strategy in sarcoma patients.</p>