Hemicorporectomy

Hemicorporectomy is a radical surgery in which the body below the waist is amputated, transecting the lumbar spine. This removes the legs, the genitalia (internal and external), urinary system, pelvic bones, anus, and rectum. It is a severely mutilating procedure recommended only as a last resort for people with severe and potentially fatal illnesses such as osteomyelitis, tumors, severe traumas and intractable decubiti in, or around, the pelvis. It has only been reported a few dozen times in medical literature.Lessons learned from battle field injuries quickened innovative treatment of congenital and acquired conditions... devised extensive cancer operations including extended radical mastectomy, radical gastrectomy and pancreatectomy, pelvic exenteration, the 'Commando Operation' (tongue, jaw and neck dissection), bilateral back dissection, hemipelvectomy, and then hemicorporectomy or translumbar amputation, referred to as the most revolutionary of all operative procedures. Hemicorporectomy is a radical surgery in which the body below the waist is amputated, transecting the lumbar spine. This removes the legs, the genitalia (internal and external), urinary system, pelvic bones, anus, and rectum. It is a severely mutilating procedure recommended only as a last resort for people with severe and potentially fatal illnesses such as osteomyelitis, tumors, severe traumas and intractable decubiti in, or around, the pelvis. It has only been reported a few dozen times in medical literature. The nomenclature is somewhat at odds with generally accepted anatomical terms, as hemi is generally used to refer to one of two sides (e.g., hemiplegia, which affects the arm and leg on one side of the body). In that sense, paracorporectomy might more closely reflect the nature of the procedure. The operation is performed to treat spreading cancers of the spinal cord and pelvic bones. Other reasons may include trauma affecting the pelvic girdle ('open-book fracture'), uncontrollable abscess or ulcers of the pelvic region (causing sepsis) or other locally uncontainable conditions. It is used in cases wherein even pelvic exenteration would not remove sufficient tissue. The surgical procedure is typically done in two stages, but it is possible to conduct the surgery in one stage. The first stage is the discontinuation of the waste functions by performing a colostomy and ileal conduit. The second stage is the amputation. With the removal of almost half of the circulatory system, cardiac function needs to be closely monitored while a new blood pressure set-point develops. Removal of large parts of the colon can lead to loss of electrolytes. Similarly, calculated measurements of renal function (such as the Cockcroft-Gault formula) are unlikely to reflect actual activity of the kidney, as these calculations were developed for patients in whom the circulatory system correlates with the body weight; this relation is lost in a post-hemicorporectomy patient. Extensive physiotherapy and occupational therapy are necessary for a patient to return to some form of normal life, which invariably involves using a wheelchair. Designing a prosthesis for the removed body parts is difficult, as there is generally no remaining pelvic girdle musculature (unless this has been spared expressly). Individuals sustaining a severe bisection injury that is essentially a de facto hemicorporectomy would rarely reach a hospital before succumbing. A study that reviewed 267 cases of patients who sustained severe blunt and penetrating trauma, and who were in cardiopulmonary arrest, found that only 7 survived long-term, only four of whom returned to their previous neurologic level. Apart from the very low likelihood of surviving such an injury, even an operative hemicorporectomy is unlikely to be successful unless the patient has 'sufficient emotional and psychological maturity to cope' and 'sufficient determination and physical strength to undergo the intensive rehabilitation'. Emergency rooms and ambulance service policies advise against the resuscitation of such patients. The UK's National Health Service, for example, in its 'Policy and Procedures for the Recognition of Life Extinct' describes traumatic hemicorporectomy (along with decapitation) as 'unequivocally associated with death' and that such injuries should be considered 'incompatible with life'. The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (COT) have also released similar position statements and policy allowing on-scene personnel to determine if patients are to be considered unresuscitatable.