Some surgical procedures are so complex, no single specialty can take them on alone. In this behind-the-scenes conversation, five surgeons reflect on what it takes to treat complex bone sarcomas, a rare form of cancer that can develop throughout the body, including the pelvis and spine [Note: sarcomas can also occur in soft tissues like muscles and fat].
These anatomically difficult, high-risk cancers demand long hours, meticulous planning, and a kind of collaborative trust and chemistry that is all too rare in the world of healthcare.
Participants:
Wakenda Tyler, MD, Orthopedic Surgeon and Musculoskeletal Oncologist
Jarrod Bogue, MD, Plastic and Reconstructive Surgeon
Justin Neira, MD, Neurosurgeon
Beatrice Dionigi, MD, Colorectal Surgeon
- Nicholas Morrissey, MD, Vascular Surgeon (brief appearance)
One Case, Many Minds
Dr. Wakenda Tyler: I think this approach has spun from the fact that we have a very diverse population of patients who come to us with really complicated problems. And those problems often can’t be addressed by just one team or specialty. It’s been amazing to bring together phenomenal experts from neurosurgery, spine, plastics, general surgery, and orthopedics to help these patients.
In most of the recent cases we've tackled together, they’ve been complex oncology patients, with tumors in anatomically difficult areas, and with high risk for morbidity and mortality. That demands a multidisciplinary approach.
Can you give an example of what each specialty contributes to a case?
Dr. Wakenda Tyler: Sure. Take our recent case, a child with Ewing sarcoma of the sacrum. As the orthopedic surgical oncologist, I focus on margins and safe tumor removal. Our neurosurgical and spine teams are thinking about nerve preservation and spinal stability. Plastics considers how to prevent wound breakdown and optimize physical recovery. General surgery makes space for us to work and ensures the colon and rectum are out of the way, and they’re also thinking ahead to prevent infection risk.
Dr. Jarrod Bogue: Then the question becomes: how do all these pieces function as one unit? What’s the order of surgery? How do we split it up? That particular case happened over two separate days. We had to plan every detail—hardware, staging, stabilization. It took at least two pre-op meetings just to debate how to carry it out.
What Each Specialty Brings to the Table
Were there moments where one specialty fundamentally changed another’s plan?
Dr. Justin Neira: Definitely. In the case before that one, we started with a piecemeal plan but ended up doing a full resection because someone raised a concern and we all thought critically about it. It wasn’t about arguing; it was about thinking together and reaching consensus. Honestly, it’s just a pleasure working with everyone here. It’s fun and easy.
Dr. Bea Dionigi: I agree. Wakenda has been an amazing captain. The collaboration is real, and we all respect each other deeply. In that last case, we thought the child would need a permanent colostomy, but we stayed open-minded and advocated hard for the patient. In the end, we avoided it. That was a huge group effort. It went beyond the textbook answer.
Dr. Justin Neira: What’s unique here is the absence of ego. I’ve worked in places where surgeons want to “own” the patient, and that makes collaboration really hard. That’s not the case here, and that makes all the difference.
Dr. Jarrod Bogue: Totally agree. This model grew organically. Wakenda and I started collaborating years ago, and she’s always open to new ideas. I suggested bringing in Bea for a diversion and VRAM flap [a reconstructive procedure in the pelvic region], and then Justin and Eduardo Beauchamp from spine. It just made sense; our personalities meshed, and the cases went really well.
Dr. Justin Neira: And our interests overlap. Wakenda’s an orthopedic oncologist. I do spine oncology. Eduardo focuses on pediatric spine. We all see the same kinds of cases from different angles.
Changing the Way We Work, and Think
Has this collaboration altered your perspective on your own specialty?
Dr. Justin Neira: Definitely. Jarrod and I are only three years into practice. Early on, you feel pressure to prove yourself, to do it all alone. But this group showed me the value of collaboration. You learn more this way.
Dr. Wakenda Tyler: Same for me. When I was early in my career, I thought I had to figure it all out alone. With experience, you realize the more help, the better—for the patient and for us.
Dr. Bea Dionigi: And these complex cases require it. We each bring such specialized skills, and the result is something none of us could achieve on our own.
How do you help patients navigate this level of complexity?
Dr. Wakenda Tyler: I tell patients from the start: this is going to be a journey. It’ll involve a team of experts. Then I introduce them to everyone who will be involved, ideally before surgery.
Dr. Jarrod Bogue: Sometimes we see patients together. Wakenda will text me, "Can you come down for an appointment?" We’ll talk in front of the patient about the plan—she covers the cancer piece; I talk about reconstruction. It shows them we’re truly a team.
Dr. Justin Neira: In our last case, I didn’t even meet the patient until the day of surgery. But because Wakenda and everyone had prepped them, they knew who I was. It was seamless.
Let’s Give It a Name
Are there plans to formalize this collaboration?
Dr. Justin Neira: Should we have a team name?
Dr. Wakenda Tyler: We need one.
Dr. Jarrod Bogue: This really started through our orthoplastics initiative, but it needs to evolve into something broader, a formal multidisciplinary surgical oncology team.
Dr. Justin Neira: These surgeries are incredibly rare. Only a few centers in the country do them.
Dr. Bea Dionigi: And we’re also building on this with early-onset cancer efforts and broader oncology collaborations. It’s probably time we named this work.
Dr. Jarrod Bogue: And the surgeries are physically intense, too. The last one was almost 24 hours straight. The one before that we split into two days.
Dr. Bea Dionigi: And it’s not just the time. The choreography matters. Jarrod starts with the flap, then we open the abdomen. He steps away while I work in the pelvis. Wakenda checks exposure. Jarrod checks if his flap will fit. We make micro-adjustments together, even organ preservation decisions.
Dr. Wakenda Tyler: Right, we don’t just do our part and leave. We’re all constantly checking in.
Dr. Bea Dionigi: And if you saw the patient after surgery, you wouldn’t guess all that went into it. The incisions are clean. The patient is doing amazing.
What’s your hope for the future of this team?
Dr. Jarrod Bogue: We need to tell people we exist. Raise awareness.
Dr. Bea Dionigi: This could be a referral center for these cancers.
Closing Thoughts
(As the conversation wrapped up, there was a moment of shared gratitude, laughter, and a cameo from vascular surgeon Dr. Nick Morrissey, who’d been quietly listening.)
Dr. Wakenda Tyler: I know Dr. Morrissey is sitting off to the sideline…
Dr. Jarrod Bogue: Yeah, I wanted to mention him.
Dr. Wakenda Tyler: We called him for a lot of cases but didn’t need him to jump in this time around.
Dr. Nick Morrissey: That’s because you guys are too good. I almost never have to do anything.
Dr. Bea Dionigi: If we call you, it means it’s a big problem!
Dr. Wakenda Tyler: That’s how we know we’re in trouble!
Any parting thoughts?
Dr. Justin Neira: We all want to invest the time to do this, because in the end, we have a great time and do something awesome.
That may be what makes this team truly exceptional.