Hemicorporectomy: a case report on a last-resort surgical procedure.

backgroundHemicorporectomy is an exceptionally rare and radical procedure reserved for highly selected patients with locally advanced pelvic malignancies without distant metastasis. Dedifferentiated sacral chordoma represents an aggressive histological subtype that may preclude conventional en bloc resection due to extensive local invasion. In such extraordinary circumstances, hemicorporectomy may be considered as a last-resort surgical strategy. CASE PRESENTATION: A 67-year-old male patient was diagnosed with a dedifferentiated sacral chordoma exhibiting extensive invasion of pelvic organs and retroperitoneal extension up to the L4 level, without distant metastasis. Following multidisciplinary evaluation, curative-intent hemicorporectomy was deemed the only feasible treatment option. The procedure was performed in a single-stage anterior-to-posterior approach, incorporating contemporary reconstructive techniques, including urinary diversion and an anterolateral thigh musculocutaneous flap. Pathological examination confirmed dedifferentiated chordoma with clear surgical margins. The postoperative period was complicated by wound-related issues requiring surgical debridement and an episode of pulmonary edema. Despite these complications, the patient achieved functional stabilization, including independent sitting and wheelchair mobilization. At six months, pulmonary metastases were detected, and palliative care was initiated. The patient died nine months after surgery due to pulmonary complications.

conclusionsThis case highlights that hemicorporectomy, though associated with significant morbidity, remains a viable curative or palliative option in carefully selected patients with locally advanced pelvic tumors. When performed with meticulous planning and multidisciplinary coordination, the procedure can provide meaningful short-term survival, symptom relief, and quality-of-life improvement in otherwise untreatable cases.