Hemicorporectomy: A Case Report on a Last-Resort Surgical Procedure

Background Hemicorporectomy is an extremely rare and radical surgical option reserved for select patients with extensive pelvic malignancies that remain confined locally despite significant regional progression. Sacral chordoma is a slow-growing but locally aggressive tumor that may reach massive dimensions before diagnosis, often rendering conventional en bloc resection impossible. In such exceptional cases, hemicorporectomy may represent the only potentially curative approach. This report presents a rare case of hemicorporectomy performed for a sacral chordoma with extensive pelvic invasion but no distant metastasis. Case presentation A 67-year-old male patient presented with a two-year history of progressive abdominal symptoms. Initial biopsy was nondiagnostic, and the patient declined repeat sampling. He later required emergent surgery for ileus, during which a second biopsy confirmed chordoma. Advanced imaging at our institution demonstrated complete invasion of pelvic organs and retroperitoneal extension up to the L4 level, without evidence of distant metastasis. A multidisciplinary team determined that curative treatment could only be achieved through hemicorporectomy. The procedure was performed in a single-stage anterior-to-posterior fashion. The operation included creation of a urinary diversion using a transverse colon segment, ligation of major pelvic vessels, preparation of a left anterolateral thigh musculocutaneous flap for reconstruction, and en bloc resection at the L3 level. Pathology confirmed a dedifferentiated chordoma with clear surgical margins. The postoperative course was complicated by wound infections requiring two debridements and an episode of pulmonary edema, but the patient achieved stable recovery and was discharged at postoperative month three. At month six, bilateral pulmonary metastases were identified, and palliative care was initiated. The patient died at postoperative month nine due to pulmonary complications. Conclusions This 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.