Presentation Details
| Building Resilience Before Division: Comprehensive Prehabilitation and Preoperative Planning for a Patient Undergoing Hemicorporectomy for High-Grade Sarcoma Vincent Bargnes, MD, Gabriel San Roman II, MD, MS, MHA, Taylor Bentz, MD, Daryn Moller, MD, Meng Wang, MD, PhD. Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA |
Abstract
CASE PRESENTATION: A 53-year-old man with high-grade spindle cell sarcoma of the pelvis was scheduled for hemicorporectomy after extensive treatment with immune checkpoint inhibitors, radiation therapy, repeat surgical resections, thoracic laminectomy with bilateral cordotomies and myelotomy for pain control, diverting colostomy, and recent creation of an ileal conduit complicated by postoperative sepsis. A comprehensive prehabilitation program was implemented to optimize his functional capacity and psychological readiness. Upper-extremity conditioning using a hand-cycle ergometer was selected to improve cardiopulmonary reserve and support expected postoperative mobility. Concurrent psychological support focused on coping strategies, expectation management, and adjustment to anticipated body-image changes. Immunotherapy cessation reduced risks of impaired wound healing and immune-related adverse events, while anemia and nutritional deficits were corrected with targeted supplementation. Following anesthesiologist-led collaborative care coordination with surgical oncology, orthopedic oncology, neurosurgery, hematology/oncology, plastic surgery, colorectal surgery, urology, critical care, and transfusion medicine, the patient underwent a hemicorporectomy without major postoperative complications. He was extubated on postoperative day 3, began wheelchair training shortly after, and demonstrated strong engagement in rehabilitation. The anesthesiology consult service provided continuous perioperative oversight, beginning with the preoperative evaluation and throughout his recovery with inpatient follow-up.
DISCUSSION: Hemicorporectomy is a rare and extreme procedure, with fewer than 100 cases reported. For this patient, his localized but highly recurrent sarcoma refractory to chemotherapy and radiation made the operation in line with his goals of care. This case illustrates the role of anesthesiologist-led, comprehensive prehabilitation in facilitating surgical preparedness. Physical conditioning supported early mobilization, psychological preparation improved postoperative adaptation, and temporary cessation of immunotherapy with macronutrient and micronutrient supplementation demonstrated the importance of individualized perioperative planning.
CONCLUSIONS: Integrated, anesthesiologist-led prehabilitation, combining physical conditioning, psychological support, and patient-centered preoperative optimization, was essential in a positive recovery following this radical oncologic surgery. Multidisciplinary coordination and early patient engagement are critical to enhancing perioperative outcomes in high-risk surgical populations.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
DISCUSSION: Hemicorporectomy is a rare and extreme procedure, with fewer than 100 cases reported. For this patient, his localized but highly recurrent sarcoma refractory to chemotherapy and radiation made the operation in line with his goals of care. This case illustrates the role of anesthesiologist-led, comprehensive prehabilitation in facilitating surgical preparedness. Physical conditioning supported early mobilization, psychological preparation improved postoperative adaptation, and temporary cessation of immunotherapy with macronutrient and micronutrient supplementation demonstrated the importance of individualized perioperative planning.
CONCLUSIONS: Integrated, anesthesiologist-led prehabilitation, combining physical conditioning, psychological support, and patient-centered preoperative optimization, was essential in a positive recovery following this radical oncologic surgery. Multidisciplinary coordination and early patient engagement are critical to enhancing perioperative outcomes in high-risk surgical populations.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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