When 10-year-old Elise Robinson felt pain in her right knee three years ago, her pediatrician thought it was growing pains.
But the pain persisted, so Elise and her parents visited an orthopedic surgeon.
Scans revealed a tumor in her right tibia, the larger of the two bones between the knee and the ankle. A biopsy confirmed the tumor was an osteosarcoma – the most common type of bone cancer in children.
Elise and her family made their way to the MD Anderson Children’s Cancer Hospital, where they met orthopedic oncologist Valerae O. Lewis, M.D. Lewis proposed a procedure called rotationplasty to remove Elise’s cancer while preserving her mobility.
To perform the procedure, surgeons remove the upper portion of the leg, the knee and several inches below the knee to ensure all cancer cells are excised.
Then they rotate the remaining portion of the lower leg 180 degrees and attach it to what’s left of the upper leg. The rotated foot is now on the same plane where the knee used to be, with the toes pointing backward and the heel facing frontward.
“In this rotated position, the ankle acts like a new knee joint,” says Lewis, chair of Orthopaedic Oncology.
The foot fits down into a prosthetic leg.
Essentially it turns an above-the-knee amputation into a below-the-knee amputation and affords the patient better control, function and mobility.
“The aim of the surgery is to offer patients the best possible functionality,” Lewis says.
“Most patients eventually will be able to walk unaided and return to the sport of their choice.”
Elise’s mom, Jennifer, at first was hesitant to agree to rotationplasty.
“I was concerned about how people would react if they saw Elise without her prosthesis,” says Jennifer. “I thought about the stares and questions from friends and family, and especially strangers.”
Elise, however, wanted to give it a try. She likes playing sports, and rotationplasty would allow her to remain active.
“Most sports are possible, Lewis says, “especially those where knee motion is important, such as bicycling, skating and soccer.”
Only 35 cases of this tumor type have ever been documented, and Kylie is one of the youngest patients ever.
Paul Gidley, M.D.
Skull base tumor surgeon
On the back of Alicia Bennett’s favorite T-shirt is her design of a tree with the words, “Go out on a limb.”
The shirt honors the 17-hour cancer operation that removed the 23-year-old college student’s watermelon-sized tumor, along with her right arm and breast, chest wall, sternum and six ribs.
“I use lots of humor to cope,” says Alicia, who has been coping with a desmoid tumor – a type of soft tissue sarcoma – since she...
“I wasn’t allowed to eat for two days prior to surgery, I had to do a bowel preparation, and I was incredibly weak when I was wheeled into the operating room.
After surgery, I was in bed for quite some time,” Jenkins recalls. “When I finally could walk around, it was really painful. After going home, I distinctly remember my husband cooking — the smell of spices made me cough, and the coughing caused such incredible pain that I had to tell him to stop.”
A decade later, when Jenkins’ cancer returned and her MD Anderson doctors determined that surgery was again necessary, she jumped at the chance to participate in a protocol designed to relieve patients’ symptom burden and improve functional recovery.
To her absolute surprise, Jenkins’ experience with her second operation was dramatically different than her first.
“The night before, I enjoyed a family dinner, drank clear liquids until two hours prior to surgery, and didn’t have to endure a bowel preparation that had caused so much discomfort,” she says. “After surgery, I had almost no pain — I was up and walking and was soon eating a full meal. I even felt well enough to talk to my friends and put on my makeup in recovery.”
The principles of MD Anderson’s Enhanced Surgical Recovery Program (ESRP) involve making interventions before, during and after surgery that get patients through their surgery and recovery process much quicker and with better outcomes.
The movement is not new. Rather, it was pioneered almost two decades ago by a group of surgeons in Europe. It’s only more recently that physicians and institutions in the United States, including MD Anderson, have started to look more closely at its components.
Actually, many surgical practices are based more on traditions and previous teachings than sound scientific evidence, explains Pedro Ramirez, M.D., professor of Gynecologic Oncology and Reproductive Medicine.
“The pioneers of the movement questioned many traditional standards of practice that had been ingrained in the care of patients before, during and after surgery, and by doing so, came up with strategies that could benefit the patient,” says Ramirez, an ESRP co-lead. “With implementation, they found that patients were recovering much faster and getting back to their regular activities much sooner, resulting in an obvious improvement in quality of life.”
A gynecology ESRP has already registered 597 patients since its initiation in November 2014. Since then, there’s been a one-day drop in average length of hospital stay, an 80% reduction in opioid consumption and an improvement in patient-reported outcomes, without noting any differences in postoperative complication rates or readmissions. The program also has significantly lowered the cost of caring for patients.
When triathlete Maria Lea De Jesus was diagnosed with early stage cervical cancer in 2014 after a routine Pap test, she feared being sidelined from her sport.
“I run -- a lot. I just can’t sit still,” says Lea, 49. She trains for endurance sports six days a week, year-round. Her accomplishments include completing over 10 marathons and two IRONMAN triathlons – a 2.4-mile swim, followed by a 112-mile bike ride and a 26.2-mile run...