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Roustemis AG, Liontos M, Trikoupis I, Karampikas V, Goumenos S, Gavriil P, Kontogeorgakos VA, Savvidou O, Papagelopoulos PJ. Limb Salvage and Pelvic Reconstruction With Endoprosthesis After Pelvic Tumor Resection: A Narrative Review. Cureus 2024; 16:e56043. [PMID: 38606257 PMCID: PMC11007484 DOI: 10.7759/cureus.56043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Periacetabular defects following tumor resection present formidable challenges in reconstruction and continue to pose clinical difficulties. Historically, treatment approaches leaned towards hindquarter amputation; however, due to associated morbidities and functional limitations, limb-sparing procedures gained prominence in the 1980s. Nevertheless, the intricacies of pelvic anatomy and the imperative of achieving wide surgical margins while preserving essential structures make pelvic tumor resection and subsequent reconstruction inherently complex. Various reconstruction modalities have been explored, including non-vascularized fibular grafts and prosthetic implants. Among these options, the LUMiC® endoprosthesis stands out as a promising solution for pelvic reconstruction post-tumor resection. Characterized by a modular design featuring a hydroxyapatite-coated stem and acetabular cup, this device has shown favorable implant survival rates in studies, despite encountering complications primarily associated with soft tissue failure, dislocation, and infection. Notably, the incidence of complications varies across studies. The Henderson classification system delineates these complications, encompassing soft tissue issues, aseptic loosening, periprosthetic fractures, infections, and tumor recurrence. Despite the encouraging functional outcomes associated with the LUMiC® endoprosthesis, it is not immune to limitations. Concerns persist regarding complications such as dislocation and infection, underscoring the imperative for further research to evaluate the long-term durability and reliability of this reconstructive approach. Moreover, advancements in surgical techniques, perioperative management, and the advent of navigation-assisted procedures hold promise for enhancing outcomes and mitigating complication rates in pelvic reconstruction surgeries.
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Affiliation(s)
- Anastasios G Roustemis
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Athens, GRC
- Medical School, Attikon University General Hospital, Athens, GRC
| | - Markos Liontos
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Athens, GRC
- Medical School, Attikon University General Hospital, Athens, GRC
| | - Ioannis Trikoupis
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Athens, GRC
- Medical School, Attikon University General Hospital, Athens, GRC
| | - Vasileios Karampikas
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Athens, GRC
- Medical School, Attikon University General Hospital, Athens, GRC
| | - Stavros Goumenos
- Department of Orthopedic Surgery, Center for Musculoskeletal Surgery, Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, DEU
| | - Panagiotis Gavriil
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Athens, GRC
- Medical School, Attikon University General Hospital, Athens, GRC
| | - Vasileios A Kontogeorgakos
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Athens, GRC
- Medical School, Attikon University General Hospital, Athens, GRC
| | - Olga Savvidou
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Athens, GRC
- Medical School, Attikon University General Hospital, Athens, GRC
| | - Panayiotis J Papagelopoulos
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Athens, GRC
- Medical School, Attikon University General Hospital, Athens, GRC
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Kim Y, Kim HS, Han I. Amputation in patients with extremity soft tissue sarcoma: the experience of an East Asian referral center. BMC Cancer 2024; 24:61. [PMID: 38212719 PMCID: PMC10782674 DOI: 10.1186/s12885-023-11813-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/31/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND This study aimed to investigate the characteristics and clinical outcomes in a series of patients with extremity soft tissue sarcoma (STS) who underwent amputation at a large East Asian referral center. PATIENTS AND METHODS Of the 652 patients who underwent surgery for extremity STS, data of 37 consecutive patients who underwent amputation were reviewed retrospectively. The median follow-up period was 96.0 months (range, 15-216). The patients were classified in to three cohorts. The primary localized (PL) group included patients who underwent amputation as a primary surgical procedure with curative intent. The recurrent localized (RL) group included patients who underwent amputation as a revision procedure after failure of previous limb sparing surgeries. The metastatic group included patients who underwent amputation as a palliative procedure. RESULTS There were 22 cases of amputation in 596 STS patients and the amputation rate was 3.6% (22/596). Further, 1.8% (9/490) of patients with primary localized STS underwent amputation. Patients with localized STS who underwent amputation had a 5-year disease-specific survival (DSS) rate of 89.9% (95% Confidence Interval (CI), 87.1-92.7%), a local-recurrence-free survival (LRFS) of 84.1% (95% CI, 80.5-87.6%), and a metastasis-free survival (MFS) of 84.6%. (95% CI, 81.1-88.0%) Compared with previous studies, our results showed higher DSS and MFS rates with similar LRFS. CONCLUSIONS The amputation rate of extremity STS in our institute in East Asia was similar but slightly lower than that reported in Western studies. The oncologic outcome of amputation reported in this study was higher than that indicated in Western studies and oncologic outcome of amputation was not statistically different from those of limb salvage surgery. However, considering the small cohort in single institute study, there is a possibility of selection bias and future multi-center study is necessary. From our results, amputation is still a feasible option for appropriately selected patients unsuitable for limb-conserving surgery.
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Affiliation(s)
- Yongsung Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno- gu, 03080, Seoul, Korea
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Korea
| | - Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno- gu, 03080, Seoul, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, 03080, Seoul, Korea
| | - Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno- gu, 03080, Seoul, Korea.
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, 03080, Seoul, Korea.
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Berner JE, Teelucksingh S, Saleh DB, Crowley TP, Ragbir M. 'Thou shalt not throw away a living thing': A single-centre 10-year experience using the spare parts principle for complex sarcoma reconstruction. J Plast Reconstr Aesthet Surg 2023; 82:3-11. [PMID: 37148808 DOI: 10.1016/j.bjps.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/04/2023] [Accepted: 04/12/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION For aggressive limb sarcomas beyond reconstructive reach, an amputation may be the only alternative to achieve a complete tumour resection. However, very proximal amputations result in greater loss of function and quality-of-life impact. The spare parts principle advocates utilising tissues distal to the amputation site, for reconstructing complex defects and preserving the function. We aim to present our 10-year experience utilising this principle in complex sarcoma surgery. METHODS A retrospective review of our prospective sarcoma database was conducted for sarcoma patients treated with an amputation between 2012 and 2022. Cases in which distal segments were used for the reconstruction were identified. Demographic data, tumour characteristics, and surgical and non-surgical treatment, along with oncological outcomes and complications, were recorded and analysed. RESULTS Fourteen patients were eligible for inclusion. The median age was 54 years at presentation (8-80 years) with 43% being females. Nine had a primary sarcoma resection, two were treated for recurrent tumours, two presented intractable osteomyelitis following sarcoma treatment and one had an amputation as a palliative procedure. The latter was the only oncological case in which tumour clearance was not achieved. Three patients developed metastasis and subsequently died during follow-up. DISCUSSION Careful balancing of oncological goals and preservation of function is required for proximal limb-threatening sarcomas. When an amputation is required, tissues distal to the cancer site provide a safe reconstructive alternative, optimising patient recovery and preserving function. Our experience is limited by the small number of cases presenting with these rare and aggressive tumours.
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Affiliation(s)
- Juan Enrique Berner
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom.
| | - Sachin Teelucksingh
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Daniel B Saleh
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Timothy P Crowley
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Maniram Ragbir
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
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Gazendam A, Popovic S, Parasu N, Ghert M. Chondrosarcoma: A Clinical Review. J Clin Med 2023; 12:jcm12072506. [PMID: 37048590 PMCID: PMC10095313 DOI: 10.3390/jcm12072506] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Chondrosarcomas are a diverse group of malignant cartilaginous matrix-producing neoplasms. Conventional chondrosarcomas are a continuum of disease based on the biologic activity of the tumor. The tumors range from the relatively biologically benign low-grade tumors or intermediate atypical cartilaginous tumors (ACTs), to malignant, aggressive high-grade tumors. The clinical presentation, radiographic and pathologic findings, treatments and outcomes vary significantly based on the histologic grade of the tumor. Chondrosarcomas present a diagnostic dilemma, particularly in the differentiation between high- and intermediate-grade tumors and that of low-grade tumors from benign enchondromas. A multidisciplinary team at a tertiary sarcoma centre allows for optimal care of these patients.
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Conti L, Buriro F, Baia M, Pasquali S, Miceli R, De Rosa L, Gronchi A, Fiore M. Contemporary role of amputation for patients with extremity soft tissue sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:934-940. [PMID: 36517316 DOI: 10.1016/j.ejso.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION limb-sparing surgery is the mainstream treatment for primary extremity soft tissue sarcoma (ESTS) at referral centers, following advances in surgical reconstructions and multimodal management. However, amputation is still needed in selected patients and has not yet been described for a ESTS cohort in a contemporary scenario. MATERIAL AND METHODS consecutive patients who underwent surgery for primary ESTS from 2006 to 2018 were extracted from a prospectively collected database at our reference center. Patients receiving amputation for either primary tumor or local recurrence (LR) after limb-sparing surgery were selected for analysis. RESULTS Among 1628 primary ESTS, 29 patients underwent primary amputation (1.8%), 22/1159 (1.9%) for upper limb and 7/469 (1.5%) for lower limb ESTS. Patients were mainly affected by grade III FNCLCC (89.6%) of notable dimension (median size 16 cm, IQR 10-24). 65.5% of patients received preoperative treatments (systemic or regional chemotherapy, radiotherapy or chemo-radiation). Secondary amputation for LR was performed after a median of 23 months in 16/1599 patients (1%). Median survival time was 16.2 and 29.6 months after primary or secondary amputation respectively. Factors prompting the need for a primary amputation were most often a combination of multifocal disease, bone invasion and pain or neurovascular bundle involvement and relevant comorbidities, mainly for grade III tumors in elderly patients. CONCLUSION Contemporary rate of amputation for ESTS at a reference center is extremely low. Still, amputation is required in selected cases with advanced presentations, especially in elderly, frail patients.
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Hu X, Chen X, Li T, Liu Z, Guo X, Ouyang Z. Effect of Cisplatin Arterial Infusion (CAI) on Primary Nonmetastatic Pelvic Osteosarcoma: A Preliminary Study. Cancer Manag Res 2021; 13:1491-1503. [PMID: 33623429 PMCID: PMC7894794 DOI: 10.2147/cmar.s294677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/28/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose The critical role of arterial infusion chemotherapy in the multimodal treatment of extremity bone cancer has been investigated extensively, but few studies have focused on pelvic osteosarcoma. Therefore, we attempted to evaluate the clinical significance of arterial infusion chemotherapy in the treatment of pelvic osteosarcoma. Patients and Methods We combined a cisplatin arterial infusion regimen with multidrug systematic chemotherapy as a neoadjuvant protocol for the treatment of pelvic osteosarcoma. The course number and dosage of cisplatin arterial infusion were adjusted to achieve a maximal tumor response evaluated by contrast-enhanced MRI per RECIST 1.1. Good responders received the same systematic combination for postoperative chemotherapy, and poor responders received second-line therapy. Twelve patients with nonmetastatic high-grade pelvic osteosarcoma were included. Survival, chemotherapy response and adverse events data were analyzed. Results The mean follow-up period was 56.1 months. Four patients died of refractory tumor progression, and 1 patient with local recurrence had no evidence of disease for 27 months after receiving secondary amputation and resection. Kaplan-Meier survival analysis demonstrated a 57.8% overall survival and 52.5% event-free survival rate at 5 years. Eight of 12 patients had a >90% tumor necrosis rate according to histopathologic examinations. The rates of local adverse events were lower than those reported for extremity osteosarcoma. Conclusion Our study initially indicated that the cisplatin arterial infusion regimen was a potential therapy with good tolerance in the treatment of pelvic osteosarcoma.
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Affiliation(s)
- Xuantao Hu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Xia Chen
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Tao Li
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Zicheng Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Xiaoning Guo
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Zhengxiao Ouyang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People's Republic of China
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Kiiski J, Laitinen MK, Nail LRL, Kuokkanen HO, Peart F, Rosset P, Bourdais-Sallot A, Jeys LM, Parry MC. Soft tissue reconstruction after pelvic amputation: The efficacy and reliability of free fillet flap reconstruction. J Plast Reconstr Aesthet Surg 2020; 74:987-994. [PMID: 33431341 DOI: 10.1016/j.bjps.2020.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The majority of hindquarter amputation defects can be reconstructed with local anterior or posterior thigh flaps. Less than 5% of soft tissue defects require free flap reconstruction after tumour resection. Lower extremity fillet flap is described for reconstructing such defects, but the majority of publications are case reports or short single institutional series. There is a lack of data regarding the oncological outcomes of this highly selected patient group. METHODS Three tertiary sarcoma units treated twelve patients with hindquarter amputation or hip disarticulation for oncological indications with a free flap reconstruction of the soft tissue defect. RESULTS The median age of patients was 60 (range 12-76) years. Bone resection was carried out through the SI-joint in six patients and through the sacrum in five patients, with one patient undergoing hip disarticulation. Nine patients had R0 resection margin and three had R1 resection. The median surgical time and flap ischaemia time was 420 (249-650) and 89 (64-210) min, respectively. Median hospital and ICU stay was 18 (10-42) and 3 (1-8) days, respectively. Median blood loss was 2400 (950-10000) ml. There were three returns to theatre due to vascular compromise, with one total flap loss due to arterial thrombosis. Overall survival was 58% (95%CI 28-91%) both at 1-year and at 3-years. DISCUSSION Carefully selected patients requiring hindquarter amputation with extensive soft tissue defect necessitating free flap reconstruction can be reconstructed with a lower extremity free fillet flap with low rate of local wound complications. Survival of these patients is similar to that in patients requiring less extensive resection.
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Affiliation(s)
- Juha Kiiski
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences Tampere, Finland.
| | - Minna K Laitinen
- Helsinki University Hospital, Department of Orthopaedics, Finland; University of Helsinki, Helsinki, Finland
| | - Louis-Romée Le Nail
- Orthopaedic Surgery Department, University Hospital of Tours, Medical University of Tours, France
| | - Hannu O Kuokkanen
- University of Helsinki, Helsinki, Finland; Helsinki University Hospital, Department of Plastic Surgery, Finland
| | | | - Philippe Rosset
- Orthopaedic Surgery Department, University Hospital of Tours, Medical University of Tours, France
| | - Aurélie Bourdais-Sallot
- Plastic and Reconstructive Surgery Department, University Hospital of Tours, Medical University of Tours, France
| | - Lee M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
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The challenge of treating elderly patients with advanced bone and soft tissue sarcomas. Crit Rev Oncol Hematol 2020; 155:103108. [DOI: 10.1016/j.critrevonc.2020.103108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/24/2020] [Accepted: 09/07/2020] [Indexed: 01/13/2023] Open
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Callegaro D, Raut CP, Keung EZ, Kim T, Le Pechoux C, Martin-Broto J, Gronchi A, Swallow C, Gladdy R. Strategies for care of patients with gastrointestinal stromal tumor or soft tissue sarcoma during COVID-19 pandemic: A guide for surgical oncologists. J Surg Oncol 2020; 123:12-23. [PMID: 33022754 PMCID: PMC7675701 DOI: 10.1002/jso.26246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic is deeply impacting the accessibility of cancer patients to surgery. In resource-limited conditions, the standard of care might not be deliverable, but evidence to support alternative management strategies often exists. By revisiting available treatment options, this review provides surgical oncologists with an evidence-based framework for treating patients with gastrointestinal stromal tumor, extremity/truncal soft tissue sarcoma, and retroperitoneal sarcoma to rapidly adapt their decision-making to the constant evolution of the COVID-19 pandemic.
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Affiliation(s)
- Dario Callegaro
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Teresa Kim
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | | | - Javier Martin-Broto
- Medical Oncology Department in University Hospital Virgen del Rocio and Institute of Biomedicine of Sevilla (IBIS) (HUVR, CSIC), University of Sevilla, Sevilla, Spain
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carol Swallow
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rebecca Gladdy
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Kiiski J, Parry MC, Le Nail LR, Sumathi V, Stevenson JD, Kaartinen IS, Jeys LM, Laitinen MK. Surgical and oncological outcomes after hindquarter amputation for pelvic sarcoma. Bone Joint J 2020; 102-B:788-794. [DOI: 10.1302/0301-620x.102b6.bjj-2019-1317.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Survival rates and local control after resection of a sarcoma of the pelvis compare poorly to those of the limbs and have a high incidence of complications. The outcome for patients who need a hindquarter amputation (HQA) to treat a pelvic sarcoma is poor. Our aim was to evaluate the patient, tumour, and reconstructive factors that affect the survival of the patients who undergo HQA for primary or recurrent pelvic sarcoma. Methods We carried out a retrospective review of all sarcoma patients who had undergone a HQA in a supraregional sarcoma unit between 1996 and 2018. Outcomes included oncological, surgical, and survival characteristics. Results A total of 136 patients, with a mean age of 51 (12 to 83) underwent HQA, 91 for a bone sarcoma and 45 for a soft tissue sarcoma. The overall survival (OS) after primary HQA for a bone sarcoma was 90.7 months (95% confidence interval (CI) 64.1 to 117.2). In patients undergoing a secondary salvage HQA it was 90.3 months (95% CI 58.1 to 122.5) (p = 0.727). For those treated for a soft tissue sarcoma (STS), the mean OS was 59.3 months (95% CI 31.1 to 88.6) for patients with a primary HQA, and 12.5 months (95% CI 9.4 to 15.5) for those undergoing a secondary salvage HQA (p = 0.038). On multivariate analysis, high histological grade (hazard ratio (HR) 2.033, 95% CI 1.127 to 3.676; p = 0.018) and a diagnosis of STS (HR 1.653, 95% CI 1.027 to 2.660; p = 0.039) were associated with a poor prognosis. The 30-day mortality for patients with curative intent was 0.8% (1/128). For those in whom surgery was carried out with palliative intent it was 33.3% (2/6) (p = 0.001). In total, 53.7% (n = 73) of patients had at least one complication with 23.5% (n = 32) requiring at least one further operation. Direct closure was inferior to flap reconstruction in terms of complete primary wound healing (60.0% (3/5) vs 82.0% (82/100); p = 0.023). Conclusion In carefully selected patients HQA is associated with satisfactory overall survival, with a low risk of perioperative mortality, but considerable morbidity. However, caution must be exercised when considering the procedure for palliation due to the high incidence of early postoperative mortality. Cite this article: Bone Joint J 2020;102-B(6):788–794.
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Affiliation(s)
- Juha Kiiski
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Michael C. Parry
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Luis-Romee Le Nail
- Orthopaedic Surgery Department, University Hospital of Tours, Medical University of Tours, Tours, France
| | - Vaiyapuri Sumathi
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan D. Stevenson
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Ilkka S. Kaartinen
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Lee M. Jeys
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Minna K. Laitinen
- Helsinki University Hospital, Department of Orthopaedics, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
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Thirty-Day Outcomes after Surgery for Primary Sarcomas of the Extremities: An Analysis of the NSQIP Database. JOURNAL OF ONCOLOGY 2020; 2020:7282846. [PMID: 32411242 PMCID: PMC7201584 DOI: 10.1155/2020/7282846] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/24/2019] [Indexed: 02/07/2023]
Abstract
Background Primary bone and soft tissue sarcomas are rare tumors requiring wide surgical resection and reconstruction to achieve local control. Postoperative complications can lead to delays in adjuvant therapy, potentially affecting long-term oncologic outcomes. Understanding postoperative complication risks is essential; however, past studies are limited by small sample sizes. Purpose This study uses a large national registry to characterize the incidence of complications and mortality in the first thirty days following surgical management of primary bone and soft tissue sarcomas of the extremities. Methods A retrospective review of patients in the National Surgical Quality Improvement Program database was performed. Cases were identified using diagnosis codes for malignant neoplasm of soft tissue or bone and procedure codes for amputation and radical resection. The cohort was subdivided by bone versus soft tissue sarcoma, upper versus lower extremity, and amputation versus limb salvage. Results One thousand, one hundred eleven patients were identified. The most frequent complications were surgical site infections, sepsis, and venous thromboembolism. The overall incidence of complications was 14.0%. Unplanned readmission and reoperation occurred after 7.0% and 8.0% of cases, respectively. Thirty-day mortality was 0.3%, with one intraoperative death. Patient factors and complication rates varied by tumor location and surgical modality. Lower extremity cases were associated with higher rates of wound complications and infectious etiologies such as surgical site infections, urinary tract infections, and systemic sepsis. In contrast, patients undergoing amputation were more likely to experience major medical complications including acute renal failure, cardiac arrest, and myocardial infarction. Conclusion Approximately 1 in 7 patients will experience a complication in the first thirty days following surgery for primary bone and soft tissue sarcomas of the extremities. The unique risk profiles of lower extremity and amputation cases should be considered during perioperative planning and surveillance.
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Gil S, Fernandez-Pineda I, Rao B, Neel MD, Baker JN, Wu H, Wu J, Anghelescu DL. Role of Amputation in Improving Mobility, Pain Outcomes, and Emotional and Psychological Well-Being in Children With Metastatic Osteosarcoma. Am J Hosp Palliat Care 2018; 36:105-110. [PMID: 30058346 DOI: 10.1177/1049909118791119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND: Few studies have analyzed the benefit of limb amputations in children with metastatic osteosarcoma and limited life span. OBJECTIVE: We studied outcomes of limb amputations in children with metastatic osteosarcoma. DESIGN: We performed a retrospective review of patients who underwent limb amputations (January 1995-June 2015) and died within 1 year of surgery. SETTING/PARTICIPANTS: We studied 12 patients with osteosarcoma at a single institution. MEASUREMENTS: Data on mobility, pain, and emotional and psychological well-being were retrieved from medical records from 1 month before surgery to 6 months after surgery. RESULTS: Of the 12 patients (7 females and 5 males; median age at surgery 13 years [range, 7-20 years]) meeting study criteria, 3 patients and 9 patients had primary osteosarcoma in upper and lower limbs, respectively. Mobility improved postamputation in 8 bedridden/wheelchair-bound patients. Postamputation, emotional, and psychological well-being improved for 9 patients, 3 patients had persistent psychological and/or emotional symptoms, and no patient experienced signs of regret. Daily mean pain scores were significantly lower at 1 week (median 3 [range, 0-6]; P = .03) and 3 months (median 0 [range, 0-8]; P = .02) postsurgery than at 1 week presurgery (median 5.5 [range, 0-10]). Morphine consumption (mg/kg/d) showed a trend toward higher values at 1 week (median 0.2 [range, 0-7.6]; P = .6) and 3 months (median 0.2 [range, 0-0.5]; P = .3) postsurgery than at 1 week presurgery (median 0.1 [range, 0-0.5]). CONCLUSIONS: Patients undergoing limb amputations had reduced pain and improved mobility and emotional and psychological well-being. Amputations are likely to benefit children with limited life expectancy.
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Affiliation(s)
- Sebastian Gil
- 1 Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Bhaskar Rao
- 1 Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael D Neel
- 1 Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Justin N Baker
- 2 Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Huiyun Wu
- 3 Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jianrong Wu
- 3 Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Doralina L Anghelescu
- 4 Division of Anesthesiology, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
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13
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Erstad DJ, Raut CP. Amputation for Sarcoma: Revisiting a 19th Century Treatment in the 21st Century. Ann Surg Oncol 2017; 25:351-353. [PMID: 29181684 DOI: 10.1245/s10434-017-6243-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Derek J Erstad
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Chandrajit P Raut
- Department of Surgery, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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