Translumbar amputation: the longest survivor--a case update.

BACKGROUND

Translumbar amputation, known also as hemicorporectomy, was first described by Kredel but was not performed until 10 years later in 1960. It appears that 44 such operations have been reported but probably several others remain unpublished.

METHODS

The operation has been performed in 44 reported patients over the past 30 years in more or less the same fashion. Most have been done as a one-stage procedure, but the author favors laparotomy and maturation of urinary and fecal diversions before doing the amputation about two weeks later.

RESULTS

Overhydration caused the death of the first three patients. This problem was avoided in the Memorial Sloan-Kettering patients by careful monitoring of central venous pressure. There were no operative deaths, but 8 of the 44 patients died within a month. Survival of cancer patients has not been good, but those with benign lesions have survived fairly well.

CONCLUSION

This case is remarkable in that, despite a rapidly advancing cancer of the bladder, the patient lived for over 28 years. It is gratifying to see that other surgeons and patients have not abandoned this most radical of all operations when no other therapy can preserve life.