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Morii T, Asano N, Nakayama R, Kikuta K, Susa M, Horiuchi K, Watanabe I, Anazawa U, Suzuki Y, Nishimoto K, Takeuchi K, Morioka H. Complications of surgery for giant cell tumor of bone in the extremities: Incidence, risk factors, management modality, and impact on functional and oncological outcomes. J Orthop Sci 2022; 27:681-688. [PMID: 33685766 DOI: 10.1016/j.jos.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to the wide variations in location, size, local invasiveness, and treatment options, the complications associated with surgery for giant cell tumor of bone have been sporadically reported. For quality assessment, fundamental data based on large-scale surveys of complications under a universal evaluation system is needed. The Dindo-Clavien classification is an evaluation system for complications based on severity and required intervention type and is suitable for the evaluation of surgery in a heterogeneous cohort. METHODS A multi-institutional retrospective survey of 141 patients who underwent surgery for giant cell tumor of bone in the extremity was performed. The incidence and risk factors of complications, type of intervention for complication control, and impact of complications on functional and oncological outcomes were analyzed using the Dindo-Clavien classification. RESULTS Forty-six cases (32.6%) had one or more complications. Of them, 18 (12.8%), 11 (7.8%), and 17 (12.1%) cases were classified as Dindo-Clavien classification grade I, II, and III complications, respectively. There were no cases with grade IV or V complications. Progression in Campanacci grading (p = 0.04), resection (over curettage, p < 0.0001), reconstruction with prosthesis (p = 0.0007), and prolonged operative duration (p = 0.0002) were significant risk factors for complications. Complications had a significant impact on function (p < 0.0001). Differences in the impact of complication types and tumor location on function were confirmed. Complications had no impact on local recurrence and metastasis development. CONCLUSION The Dindo-Clavien classification could provide fundamental information, under a uniform definition and classification system, on postoperative complications in patients with giant cell tumor of bone in terms of incidence, type of intervention for complication control, risk factors, and impact on functional outcome. The data are useful not only for preoperative evaluation for the risk of complications under specific conditions but also for quality assessment of surgery for giant cell tumor of bone.
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Affiliation(s)
- Takeshi Morii
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611 Japan.
| | - Naofumi Asano
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazutaka Kikuta
- Department of Orthopaedic Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Michiro Susa
- Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Keisuke Horiuchi
- Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Itsuo Watanabe
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Ukei Anazawa
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Yoshihisa Suzuki
- Department of Orthopaedic Surgery, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa, Tokyo, 190-8531, Japan
| | - Kazumasa Nishimoto
- Department of Orthopaedic Surgery, Kawasaki Municipal Ida Hospital, 2-27-1 Ida, Nakahara-ku, Kawasaki, Kanagawa, 211-0035, Japan
| | - Katsuhito Takeuchi
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10, Konandai Konan-ku, Yokohama, Kanagawa, 234-0054, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization, Tokyo Medical Center., 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
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