Hemicorporectomy is a

radical surgery Radical surgery, also called radical dissection, is surgery that is more extensive than "conservative" surgery. In surgical oncology, radical surgery is surgery intended to remove both a tumor and any metastases thereof, for diagnostic and/or tre ...

in which the body below the

waist The waist is the part of the Human abdomen, abdomen between the rib cage and Hip (anatomy), hips. Normally, it is the narrowest part of the torso. ''Waistline'' refers to the horizontal line where the waist is narrowest, or to the general appe ...

is amputated, transecting the

lumbar spine The lumbar vertebrae are located between the thoracic vertebrae and pelvis. They form the lower part of the back in humans, and the tail end of the back in quadrupeds. In humans, there are five lumbar vertebrae. The term is used to describe t ...

. This removes the

leg A leg is a weight-bearing and locomotive anatomical structure, usually having a columnar shape. During locomotion, legs function as "extensible struts". The combination of movements at all joints can be modeled as a single, linear element cap ...

s, the

genitalia A sex organ, also known as a reproductive organ, is a part of an organism that is involved in sexual reproduction. Sex organs constitute the primary sex characteristics of an organism. Sex organs are responsible for producing and transporting ...

(internal and external),

urinary system The human urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, urinary bladder, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume ...

pelvic The pelvis (: pelves or pelvises) is the lower part of an anatomical trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis or pelvic skeleton). ...

bones,

anus In mammals, invertebrates and most fish, the anus (: anuses or ani; from Latin, 'ring' or 'circle') is the external body orifice at the ''exit'' end of the digestive tract (bowel), i.e. the opposite end from the mouth. Its function is to facil ...

, and

rectum The rectum (: rectums or recta) is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. Before expulsion through the anus or cloaca, the rectum stores the feces temporarily. The adult ...

. It is a major procedure recommended only as a last resort for people with severe and potentially fatal illnesses such as

osteomyelitis Osteomyelitis (OM) is the infectious inflammation of bone marrow. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The feet, spine, and hips are the most commonly involved bones in adults. The cause is ...

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

s, severe traumas and intractable decubiti in, or around, the

pelvis The pelvis (: pelves or pelvises) is the lower part of an Anatomy, anatomical Trunk (anatomy), trunk, between the human abdomen, abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also c ...

. By 2009, 66 cases had been reported in medical literature.

Medical uses

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 An abscess is a collection of pus that has built up within the tissue of the body, usually caused by bacterial infection. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pre ...

ulcer An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughin ...

s of the pelvic region (causing

sepsis Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage of sepsis is followed by suppression of the immune system. Common signs and s ...

) or other locally uncontainable conditions. It is used in cases wherein even

pelvic exenteration Pelvic exenteration (or pelvic evisceration) is a radical surgical treatment that removes all organs from a person's pelvic cavity. It is used to treat certain advanced or recurrent cancers. The urinary bladder, urethra, rectum, and anus are rem ...

would not remove sufficient tissue.

Procedure

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 A colostomy is an opening (stoma) in the large intestine (colon), or the surgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it int ...

and

ileal conduit An ileal conduit urinary diversion is one of various surgical techniques for urinary diversion. It has sometimes been referred to as the Bricker ileal conduit after its inventor, Eugene M. Bricker. It is a form of incontinent urostomy, and was de ...

in the upper abdominal quadrants. The second stage is the amputation at the

Considerations

With the removal of almost half of the circulatory system,

cardiac The heart is a muscular organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrients to the tissu ...

function needs to be closely monitored while a new

blood pressure Blood pressure (BP) is the pressure of Circulatory system, circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term ...

set-point develops. Removal of large parts of the colon can lead to loss of

electrolytes An electrolyte is a substance that conducts electricity through the movement of ions, but not through the movement of electrons. This includes most soluble salts, acids, and bases, dissolved in a polar solvent like water. Upon dissolving, t ...

. Similarly, calculated measurements of

renal function Assessment of kidney function occurs in different ways, using the presence of symptoms and signs, as well as measurements using urine tests, blood tests, and medical imaging. Functions of a healthy kidney include maintaining a person's flu ...

(such as the Cockcroft-Gault formula) are unlikely to reflect actual activity of the

kidney In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organ (anatomy), organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and rig ...

, 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.

Rehabilitation

Extensive

physiotherapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...

and

occupational therapy Occupational therapy (OT), also known as ergotherapy, is a healthcare profession. Ergotherapy is derived from the Greek wiktionary:ergon, ergon which is allied to work, to act and to be active. Occupational therapy is based on the assumption t ...

are necessary after the procedure. A return to mobility generally involves the use of a

wheelchair A wheelchair is a mobilized form of chair using two or more wheels, a footrest, and an armrest usually cushioned. It is used when walking is difficult or impossible to do due to illnesses, injury, disabilities, or age-related health conditio ...

and potentially a prosthetic. Designing a

prosthesis In medicine, a prosthesis (: prostheses; from ), or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through physical trauma, disease, or a condition present at birth (Congenital, congenital disord ...

for the removed body parts is difficult, as there is generally no remaining

pelvic girdle The hip bone (os coxae, innominate bone, pelvic bone or coxal bone) is a large flat bone, constricted in the center and expanded above and below. In some vertebrates (including humans before puberty) it is composed of three parts: the Ilium (bone) ...

musculature (unless this has been spared expressly).

Traumatic hemicorporectomy

Individuals sustaining a severe bisection injury that is essentially a '' de facto'' hemicorporectomy rarely reach a hospital before dying. 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 room An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pat ...

s and ambulance service policies advise against the resuscitation of such patients. The UK's

National Health Service The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...

, for example, in its "Policy and Procedures for the Recognition of Life Extinct" describes traumatic hemicorporectomy (along with

decapitation Decapitation is the total separation of the head from the body. Such an injury is invariably fatal to humans and all vertebrate animals, since it deprives the brain of oxygenated blood by way of severing through the jugular vein and common c ...

) as "unequivocally associated with death" and that such injuries should be considered " incompatible with life" in patients under 18. 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. In one case documented by the '' Archives of Emergency Medicine'' in 1989, a woman who sustained a complete corporal transection (hemicorporectomy) after being struck by a train arrived at a hospital in a "fully conscious" state and "was aware of the nature of her injury and wished for further treatment". Although the patient was initially stabilized and underwent three hours of emergency surgery, she died approximately two hours later due to "

hypovolemia Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the loss ...

cardiac arrhythmia Arrhythmias, also known as cardiac arrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. Essentially, this is anything but normal sinus rhythm. A resting heart rate that is too fast – above 100 beat ...

and biochemical imbalance".

Prosthesis

Following a hemicorporectomy, patients are fitted with a socket-type prosthesis often referred to as a bucket. Early bucket designs often presented significant pressure problems for patients, but new devices have incorporated an inflatable rubber lining composed of air pockets that evenly distributes pressure based on the patient's motions. Two openings at the front of the bucket create space for the colostomy bag and the

History

The development of surgical medicine was vastly accelerated during, and following, the

Second World War World War II or the Second World War (1 September 1939 – 2 September 1945) was a World war, global conflict between two coalitions: the Allies of World War II, Allies and the Axis powers. World War II by country, Nearly all of the wo ...

. Rarely-experienced traumas were made more common by new weaponry. This required decisive surgical action as well as the development of new techniques. As B. E. Ferrara stated in his summative article on hemicorporectomy,

Lessons learned from battlefield injuries quickened innovative treatment of congenital and acquired conditions ... he general surgeondevised extensive cancer operations including extended radical
mastectomy Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer choose to have ...
, radical
gastrectomy A gastrectomy is a partial or total surgical removal of the stomach. Indications Gastrectomies are performed to treat stomach cancer and perforations of the stomach wall. For severe duodenal ulcers, it may be necessary to remove the lower ...
and
pancreatectomy In medicine, a pancreatectomy is the surgical removal of all or part of the pancreas. Several types of pancreatectomies exist, including pancreaticoduodenectomy (Whipple procedure), distal pancreatectomy, segmental pancreatectomy, and total pancr ...
,
pelvic exenteration Pelvic exenteration (or pelvic evisceration) is a radical surgical treatment that removes all organs from a person's pelvic cavity. It is used to treat certain advanced or recurrent cancers. The urinary bladder, urethra, rectum, and anus are rem ...
, the '
Commando Operation The COMMANDO Operation or COMMANDO Procedure (COMbined MAndibulectomy and Neck Dissection Operation) is a complicated operation for 1st degree malignancy of the tongue.
' (tongue, jaw and neck dissection), bilateral back dissection,
hemipelvectomy Hemipelvectomy, also known as a pelvic resection, is a surgical procedure that involves the removal of part of the pelvic girdle. This procedure is most commonly performed to treat oncologic conditions of the pelvis. Hemipelvectomy can be furthe ...
, and then hemicorporectomy or translumbar amputation, referred to as the most revolutionary of all operative procedures.

It was into this environment that Frederick E. Kredel first proposed the operation in February 1951 while discussing a paper on pelvic exenteration.

List of people with hemicorporectomy

* Tammy Reed who was known as Angel, had a hemicorporectomy in 2010. Angel was a paraplegic and without the surgery, chronic sores and infection would have killed her within 18 months. Angel passed away on 25 March 2019. *Army Sgt. Joseph Grabianowski had a hemicorporectomy in 2012 after a road side bomb and a buried explosive severely injured him in Afghanistan. * Loren Schauers, an American man, had a hemicorporectomy in 2019 after a traumatic forklift accident. Loren and his wife Sabia have a YouTube channel where they document Loren’s new lifestyle without half of his body.

References

External links

* {{cite journal, title=A New Concept in Prosthetic Interface Design for Hemicorporectomy Amputees Using ROHO Compression Therapy: A Case Study From a CPO's Perspective, author=Wilson, Jon D., journal=Journal of Prosthetics & Orthotics, date=October 2004, volume=16, issue=4, doi=10.1097/00008526-200410000-00003, s2cid=72553863, pages=104–112, doi-access=free Surgical oncology Surgical removal procedures Types of amputation