Ewing's Sarcoma Specialist Surgeon Singapore

Multidisciplinary Resection and Pediatric Limb Salvage 

Ewing's sarcomas are the most common primary malignant solid tumor of bone in the first decade of life and are more common in the pelvis and spine in this age group. Treatment involves the use of chemotherapy and surgery. Radiation is also usually necessary but with surgery the radiation dose can be reduced.

We manage Ewing’s sarcoma as a high-stakes coordination of systemic control and local surgical precision. Under the surgical direction of Dr. Saminathan Suresh Nathan, we execute aggressive resections following neoadjuvant protocols to ensure definitive local control. Our practice specializes in the unique mechanical demands of pediatric limb salvage, utilizing epiphysiodesis and expandable implants to maintain structural symmetry as the skeletal frame matures over decades.

Surgical Considerations

• Biological Reconstruction: Prioritizing vascularized grafts and biological fixation to ensure the reconstruction outlives the patient's growth phase.

• Expandable Technology: Deployment of non-invasive expandable prostheses to manage limb-length discrepancy in the growing child.

• Post-Chemotherapy Planning: Dynamic 3D planning to re-evaluate resection margins after tumor shrinkage following systemic induction.

Figure 1. Survival for Ewing's sarcoma used to be considered uniformly fatal but with better chemotherapy and radiation has improved to being as good as osteosarcoma.

Figure 2. Ewing's sarcoma is a primitive neuroectodermal tumor (PNET) in a family of tumors that are characterised by small blue round cells (a). Depending on where they originate they can have various confusing names (b).

Figure 3. This 10-year old boy presented with an Ewing's sarcoma over the right acetabulum. With good chemotherapy we were able to save the hip by recycling the cryo-preserved tumor-bearing acetabulum. Six years later despite a mild loss of growth the patient walks well with this hip.