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Broida SE, Sullivan MH, Barlow JD, Morrey M, Scorianz M, Wagner ER, Sanchez-Sotelo J, Rose PS, Houdek MT. Oncological and functional outcomes after resection of malignant tumours of the scapula. Bone Joint J 2023; 105-B:1314-1320. [PMID: 38035605 DOI: 10.1302/0301-620x.105b12.bjj-2023-0552.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Aims The scapula is a rare site for a primary bone tumour. Only a small number of series have studied patient outcomes after treatment. Previous studies have shown a high rate of recurrence, with functional outcomes determined by the preservation of the glenohumeral joint and deltoid. The purpose of the current study was to report the outcome of patients who had undergone tumour resection that included the scapula. Methods We reviewed 61 patients (37 male, 24 female; mean age 42 years (SD 19)) who had undergone resection of the scapula. The most common resection was type 2 (n = 34) according to the Tikhoff-Linberg classification, or type S1A (n = 35) on the Enneking classification. Results The ten-year disease-specific survival was 76%. High tumour grade (hazard ratio (HR) 4.27; p = 0.016) and a total resection of the scapula (HR 3.84; p = 0.015) were associated with worse survival. The ten-year metastasis-free and local recurrence-free survivals were 82% and 86%, respectively. Total scapular resection (HR 6.29; p = 0.004) was associated with metastatic disease and positive margins were associated with local recurrence (HR 12.86; p = 0.001). At final follow-up, the mean shoulder forward elevation and external rotation were 79° (SD 62°) and 27° (SD 25°), respectively. The most recent functional outcomes evaluated included the mean Musculoskeletal Tumor Society Score (76% (SD 17%)), the American Shoulder and Elbow Score (73% (SD 20%)), and the Simple Shoulder Test (7 (SD 3)). Preservation of the glenoid (p = 0.001) and scapular spine (p < 0.001) improved clinical outcomes; interestingly, preservation of the scapular spine without the glenoid improved outcomes (p < 0.001) compared to preservation of the glenoid alone (p = 0.05). Conclusion Resection of the scapula is a major undertaking with an oncological outcome related to tumour grade, and a functional outcome associated with the status of the scapular spine and glenoid. Positive resection margins are associated with local recurrence.
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Affiliation(s)
- Samuel E Broida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA
| | | | | | - Mark Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA
| | - Maurizio Scorianz
- Orthopaedic Oncology and Reconstructive Unit, Careggi University Hospital, Florence, Italy
| | - Eric R Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, Georgia, USA
| | | | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA
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Augustin DH, Augustin D, Khawly CGP, Pharol A, Exantus L. Aggressive Giant Cell Tumor of the Scapula in a 35-Year-Old Woman. Cureus 2022; 14:e25553. [PMID: 35783873 PMCID: PMC9246718 DOI: 10.7759/cureus.25553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/05/2022] Open
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Timbergen MJM, van de Poll-Franse LV, Grünhagen DJ, van der Graaf WT, Sleijfer S, Verhoef C, Husson O. Identification and assessment of health-related quality of life issues in patients with sporadic desmoid-type fibromatosis: a literature review and focus group study. Qual Life Res 2018; 27:3097-3111. [PMID: 30014458 PMCID: PMC6244798 DOI: 10.1007/s11136-018-1931-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2018] [Indexed: 02/01/2023]
Abstract
PURPOSE Sporadic desmoid-type fibromatosis (DTF) is a rare, chronic, non-metastasising, disease of the soft tissues. It is characterised by local invasive and unpredictable growth behaviour and a high propensity of local recurrence after surgery thereby often having a great impact on health-related quality of life (HRQL). This study aims to review currently used HRQL measures and to asses HRQL issues among DTF patients. METHODS A mixed methods methodology was used consisting of (1) a systematic literature review, according to the PRISMA guidelines (2009), using search terms related to sporadic DTF and HRQL in commonly used databases (e.g. Embase, Medline Ovid, Web of science, Cochrane Central, Psyc Info, and Google scholar), to provide an overview of measures previously used to evaluate HRQL among DTF patients; (2) focus groups to gain insight into HRQL issues experienced by DTF patients. RESULTS The search strategy identified thirteen articles reporting HRQL measures using a wide variety of cancer-specific HRQL tools, functional scores, symptom scales (e.g. NRS), and single-item outcomes (e.g. pain and functional impairment). No DTF-specific HRQL tool was found. Qualitative analysis of three focus groups (6 males, 9 females) showed that participants emphasised the negative impact of DTF and/or its treatment on several HRQL domains. Six themes were identified: (1) diagnosis, (2) treatment, (3) follow-up and recurrence, (4) physical domain, (5) psychological and emotional domain, and (6) social domain. CONCLUSION A DTF-specific HRQL tool and consensus regarding the preferred measurement tool among DTF patients is lacking. Our study indicates that HRQL of DTF patients was negatively affected in several domains. A DTF-specific HRQL measure could improve our understanding of short- and long-term effects and, ideally, can be used in both clinic and for research purposes.
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Affiliation(s)
- Milea J M Timbergen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands.
- Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands.
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands
| | - Winette T van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
- Division of Clinical Studies, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands
| | - Olga Husson
- Division of Clinical Studies, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
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Mimata Y, Nishida J, Nagai T, Tada H, Sato K, Doita M. Importance of latissimus dorsi muscle preservation for shoulder function after scapulectomy. J Shoulder Elbow Surg 2018; 27:510-514. [PMID: 29269139 DOI: 10.1016/j.jse.2017.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/15/2017] [Accepted: 09/20/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapulectomy is an inevitable treatment for sarcomas of the scapula. This procedure is unavoidable because it reduces the local recurrence rate but can impair shoulder movements and affect the activities of daily living. This study investigated the factors influencing functional outcomes after scapulectomy. MATERIALS AND METHODS The clinical results of 8 patients (5 males, 3 females) who were diagnosed with primary or metastatic sarcomas of the scapula were retrospectively reviewed. The mean age was 49 years (range, 11-86 years). We examined the correlation between the type of excision of the scapula (total, subtotal, or partial) and postoperative functional outcomes according to the Musculoskeletal Tumor Society (MSTS) score. In partial excision, the glenohumeral joint was preserved; in subtotal excision, the glenoid was completely resected and some bony components were preserved; and in total excision, the entire bony component of the scapula was resected. The average follow-up period was 55 months (range, 9-142 months). RESULTS The partial, subtotal, and total excision groups had mean functional scores of 96.7%, 76.7%, and 62.2%, respectively. Although the mean functional scores were lower in patients who underwent total and subtotal excisions, 3 patients in whom the latissimus dorsi muscle was preserved had better function (mean MSTS score, 76.7%) than the 2 patients in whom it was not preserved (mean MSTS score, 55.0%). CONCLUSION These results suggest that the latissimus dorsi muscle, along with the deltoid and pectoralis major muscles, is one of the stabilizers of the proximal humerus after scapulectomy.
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Affiliation(s)
- Yoshikuni Mimata
- Department of Orthopaedic Surgery, Iwate Medical University, School of Medicine, Morioka, Japan.
| | - Jun Nishida
- Department of Orthopedic Surgery, Tokyo Medical University, School of Medicine, Tokyo, Japan
| | - Taro Nagai
- Department of Orthopedic Surgery, Tokyo Medical University, School of Medicine, Tokyo, Japan
| | - Hiroshi Tada
- Department of Orthopaedic Surgery, Iwate Medical University, School of Medicine, Morioka, Japan
| | - Kotaro Sato
- Department of Orthopaedic Surgery, Iwate Medical University, School of Medicine, Morioka, Japan
| | - Minoru Doita
- Department of Orthopaedic Surgery, Iwate Medical University, School of Medicine, Morioka, Japan
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Nota SPFT, Russchen MJAM, Raskin KA, Mankin HJ, Hornicek FJ, Schwab JH. Functional and oncological outcome after surgical resection of the scapula and clavicle for primary chondrosarcoma. Musculoskelet Surg 2017; 101:67-73. [PMID: 27900545 DOI: 10.1007/s12306-016-0437-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/06/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The scapula is a relatively common site for chondrosarcoma to develop in contrary to the clavicle, which is rarely affected by these tumors. The aim of this study is to determine the functional and oncological outcome for patients treated operatively for scapular or clavicular chondrosarcoma. METHODS In this single-center retrospective study, we included a sample of 20 patients that received the diagnosis of a primary chondrosarcoma of the scapula or clavicle. Of the surviving patients, the functional function was assessed using the DASH and the PROMIS Physical Function-Upper Extremity. Patients were longitudinally tracked for their oncological outcome. RESULTS All patients were followed for at least 2 years or until death. The mean age of the cohort was 47 years. Eighteen patients suffered from a chondrosarcoma of the scapula, and in 2 patients, the tumor was located in the clavicle. Metastasis, local recurrence and a higher tumor grade were all associated with a decreased overall survival. For the patients with a chondrosarcoma of the scapula, the average DASH score was 16 ± 16 and the mean PROMIS Physical Function-Upper Extremity score was 48 ± 10. Patients with both an intact rotator cuff and glenoid had a better physical function. CONCLUSIONS Upper extremity function after (partial) scapulectomy varied depending on whether the glenoid was spared and whether a functioning shoulder abductor remained. When the resection spared these structures, then excellent functional outcomes were reported. Oncologic outcomes depended upon the grade of the tumor and whether local recurrence and metastases occurred.
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Affiliation(s)
- S P F T Nota
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA.
| | - M J A M Russchen
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA
| | - K A Raskin
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA
| | - H J Mankin
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA
| | - F J Hornicek
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA
| | - J H Schwab
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA
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Reconstruction with scapular hemiarthroplasty endoprosthesis after scapulectomy for malignant tumour. INTERNATIONAL ORTHOPAEDICS 2017; 41:1057-1063. [PMID: 28265740 DOI: 10.1007/s00264-017-3429-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 02/08/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE Recently, endoprosthesis reconstruction has been used for scapular malignant tumours. Our aim is to present and evaluate the clinical indications, peri-operative technique, and mid-term clinical results. METHODS Scapular hemiarthroplasty after total scapulectomy has been performed in 15 patients between 2011 and 2014. Clinical records and radiographs were evaluated retrospectively. RESULTS The average follow-up was 41.2 months. No infection, dislocation, pressure ulcer, wound healing problems or mechanical failures were reported. Three patients died due to lung metastasis. The final follow-up average Musculoskeletal Tumor Society (MSTS) scoring system score was 25.3 points. The average ranges of motion of shoulder abduction and forward flexion were 45.3°and 65.7°, respectively. There were significant differences in function, lifting ability, MSTS scores, abduction function and flexion function between the seven patients with artificial ligament reconstruction for articular capsule and the others with direct suture. Three patients who had reconstruction of the rotator cuff were verified to gain better post-operative hand positioning, lifting ability, MSTS score, and abduction function than the others without rotator cuff reconstruction. CONCLUSIONS As long as the indications and surgical skills are fully mastered, reconstruction with the scapular hemiarthroplasty endoprosthesis can result in mid-term oncologic salvage, good post-operative function and low complication rate after scapulectomy for malignant tumors.
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Xu SF, Yu XC, Xu M, Hu YC, Liu XP. Functional Results and Emotional Acceptance after Scapulectomy for Malignant Shoulder Tumors. Orthop Surg 2017; 8:186-95. [PMID: 27384727 DOI: 10.1111/os.12248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/07/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To demonstrate the functional results and emotional acceptance after scapulectomy for various malignant shoulder tumors. METHODS Eight patients with malignant shoulder tumors who had undergone scapulectomy between April 2004 and March 2014 were retrospectively reviewed. They comprised seven men and one woman their mean age was 54 years (range, 24-69 years). All patients were diagnosed by pathological examination of biopsy specimens. The tumors were metastatic in four cases, having originated from a primary carcinoma of the liver in one patient, the lung in one patient and the kidney in two patients. The other four patients had primary malignant tumors in their scapulae, specifically, two scapular malignant fibrous histiocytomas, one scapular Ewing sarcoma and one soft tissue synovial sarcoma. The four patients with metastases were staged as III, and other four were staged as IIB. Six patients underwent total and two subtotal scapulectomy. The remaining soft tissues were sutured together directly in seven of the patients. The remaining patient, who had soft tissue synovial sarcoma, required transfer of a pedicle latissimus dorsi muscle flap. The functional results and emotional acceptance were evaluated by clinician using the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS The average duration of follow-up was 22.8 months. Four patients were continuously disease-free, three patients developed metastases and died of disease within 12 months of surgery and one patient with a scapular metastasis from the kidney survived with pulmonary nodules. No major complications, including infection or dislocation, occurred during or after surgery. The mean MSTS score was 16.3 (54%), which is similar to that previously reported in other studies of scapulectomy. There were no local tumor recurrences and only one patient developed pulmonary metastases. These outcomes are similar to those reported for scapular prostheses and there were fewer complications than in patients treated with allografts. The mean emotional acceptance score was 3.6 (72.5%). CONCLUSIONS Performing scapulectomies on patients with malignant shoulder tumors without prostheses or allograft reconstruction achieves good functional results and emotional acceptance with a low rate of complications.
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Affiliation(s)
- Song-Feng Xu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
| | - Xiu-Chun Yu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
| | - Ming Xu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
| | - Yong-Cheng Hu
- Department of Orthopaedic Oncology, Tianjin Hospital, Tianjin Medical University, Tianjin, China
| | - Xiao-Ping Liu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
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Abstract
The scapula plays a central role in shoulder motion and stability. A wide variety of anatomic variants as well as traumatic, neoplastic, and infectious pathologies can involve the scapula. Detection of scapular lesions using radiography can be challenging because of the obscuration by the overlying structures or incomplete imaging during shoulder magnetic resonance imaging or computed tomography examinations. Familiarity with imaging characteristics of these abnormalities will allow radiologists to better diagnose and characterize scapular disorders.
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Hayashi K, Niu X, Tang X, Singh VA, Asavamongkolkul A, Kawai A, Yamamoto N, Shirai T, Takeuchi A, Kimura H, Miwa S, Tsuchiya H. Experience of total scapular excision for musculoskeletal tumor and reconstruction in eastern Asian countries. J Bone Oncol 2016; 9:55-58. [PMID: 29234592 PMCID: PMC5715228 DOI: 10.1016/j.jbo.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 10/31/2022] Open
Abstract
Total scapulectomy and reconstruction has been performed for scapular tumor, however, most of the reconstruction methods have resulted in poor functional outcomes and there is still room for improvement. Most of the reports of reconstruction after scapulectomy are from a single institution. In the present study, we investigated functional outcomes after total scapulectomy in a multicenter study in The Eastern Asian Musculoskeletal Oncology Group (EAMOG). Thirty-three patients who underwent total scapulectomy were registered at EAMOG affiliated hospitals. The patients were separated into no reconstruction group (n=8), humeral suspension group (n=15) and prosthesis group (n=10). Functional outcome was assessed by the Enneking score. One-way ANOVA was used to compare parameters between the patient groups. Complications included five local recurrences, one superficial infection, one dislocation and one clavicle protrusion. The average follow-up period was 43.5 months. The average active flexion range was 45.8° (0-120°), and 37.1° in abduction (0-120°). The mean total functional score was 22.9 out of 30 (15-29), which is a satisfactory score following resection of the shoulder girdle. There were significant differences in reconstruction methods for active range of motion. Bony reconstruction provided better range of motion in this study. There was a variety of reconstruction methods after scapulectomy in the eastern Asian countries. Although better functional score was obtained using scapular prosthesis or recycled bone and prosthesis composite grafting, postoperative function is still lower than preoperative function. Modified designed prosthesis with or without combination of recycle bone or allograft would restore the lost shoulder function in the future.
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Affiliation(s)
- Katsuhiro Hayashi
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Xiaohui Niu
- Orthopaedic Oncology Department, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China
| | - Xiaodong Tang
- Masculoskeletal Tumor Center, People's Hospital Pecking University, Beijing 100044, China
| | - Vivek Ajit Singh
- Department of Orthopaedic Surgery, University Malaya Medical Center, 50603 Kuala Lumpur, Malaysia
| | - Apichat Asavamongkolkul
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok 10700, Thailand
| | - Akira Kawai
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Chuo-ku, Tsukiji, Tokyo 104-0045, Japan
| | - Norio Yamamoto
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Toshiharu Shirai
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Hiroaki Kimura
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Shinji Miwa
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
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Subtotal Scapulectomy With Scapulothoracic Fusion and Local Tendon Transfer for Management of Chondrosarcoma. J Am Acad Orthop Surg 2016; 24:405-9. [PMID: 27115794 DOI: 10.5435/jaaos-d-16-00048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Scapulectomy can dramatically alter glenohumeral function and the ability of patients to conduct activities of daily living. In oncologic cases, treatment of the tumor can compromise local musculature, making successful reconstruction difficult to achieve. Depending on the resection level, local musculature may be inadequate to restore shoulder range of motion and/or glenohumeral stability. Surgeons have attempted to address these issues via soft-tissue repairs, allograft replacement, and prosthetic replacement, with variable success. Outcomes are better when a greater portion of the scapula is preserved, thus saving functional rotator cuff muscle bellies. However, preservation of significant rotator cuff musculature is not routinely possible. To our knowledge, no authors in the English-language orthopaedic literature have reported on local tendon transfers as a technique to augment and reconstruct the rotator cuff in a patient with previous scapulectomy.
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Montinaro V, Boston SE, Buracco P, Culp WTN, Romanelli G, Straw R, Ryan S. Clinical outcome of 42 dogs with scapular tumors treated by scapulectomy: a Veterinary Society of Surgical Oncology (VSSO) retrospective study (1995-2010). Vet Surg 2014; 42:943-50. [PMID: 24433298 DOI: 10.1111/j.1532-950x.2013.12066.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 01/08/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report signalment, clinical signs, preoperative staging tests, histologic diagnosis, surgical, and oncologic outcomes including postoperative limb use, in dogs with scapular tumors treated by scapulectomy. STUDY DESIGN Retrospective case series ANIMALS Dogs (n = 42) with scapular tumors. METHODS Medical records (1995-2010) from 6 hospitals were searched for dogs with scapular tumors treated by scapulectomy. Data retrieved were: signalment, weight, percentage of scapula removed, histologic diagnosis, postoperative limb use, adjunctive therapy, disease free interval (DFI), and survival time (ST). Individual variables were modeled with a Cox proportional hazard model accounting for censoring to determine risk factors for decreased DFI and ST. For categorical variables, Kaplan-Meier survival plots as well as mean and median survival times (MSTs) were calculated. RESULTS Subtotal scapulectomy was performed in 18 dogs (42.9%). Osteosarcoma (OSA) was diagnosed in 27 dogs (64.3%). Limb use was evaluated immediately after surgery in 41 dogs. Information on limb use at other times (1, 2, 3, and >3 months) postoperatively was also available for some dogs and was good to excellent overall. Only adjunctive chemotherapy had a positive significant effect on DFI (P = .00011) and ST (P = .0003). CONCLUSION Canine scapular tumors can be treated effectively by scapulectomy and limb use is fair to excellent for most dogs. OSA was the most common scapular tumor. Overall prognosis for scapular OSA is similar to appendicular OSA at other sites and use of adjunctive chemotherapy prolonged the overall DFI and MST.
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Affiliation(s)
- Vincenzo Montinaro
- Department for Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada
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12
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Primary malignant tumours of the scapula—a review of 29 cases. INTERNATIONAL ORTHOPAEDICS 2014; 38:2155-62. [DOI: 10.1007/s00264-014-2417-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 06/04/2014] [Indexed: 02/07/2023]
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Tumors of the coracoid process: clinical evaluation of twenty-one patients. J Shoulder Elbow Surg 2012; 21:1508-15. [PMID: 22326544 DOI: 10.1016/j.jse.2011.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 11/03/2011] [Accepted: 11/06/2011] [Indexed: 02/01/2023]
Abstract
OBJECTIVE We present the incidence and management of bone tumors of the coracoid process and discuss the related clinical and imaging findings and treatment. MATERIALS AND METHODS We present 21 patients (7 males and 14 females; mean age, 39 years) treated for bone tumors of the coracoid process from 1900 to 2010. Mean follow-up was 44 months (range, 12-132 months). Clinical presentation, imaging, surgical treatment, complications, range of shoulder motion, and Musculoskeletal Tumor Society (MSTS) function were evaluated. RESULTS Bone tumors were benign in 7 (33%) and malignant in 14 (67%). The most common were chondrosarcomas, osteoblastomas, and chondroblastomas. The most common presentation was pain and palpable mass for a mean duration of 11 months. Limb salvage, with or without megaprosthetic reconstruction, was achieved in 20 patients. One patient required forequarter amputation. One patient with chondroblastoma and 2 with chondrosarcoma had local recurrence. The range of shoulder motion varied according to the type of resection: patients with curettage and limited resections without involvement of the abductor mechanism had better shoulder motion, and patients with scapulectomy and proximal humeral resections had significant limitations of motion. The mean MSTS score was 80% (range, 50%-100%). CONCLUSIONS Chondrosarcomas, osteoblastomas, and chondroblastomas are the most common bone tumors of the coracoid process. Limited resections are associated with nearly normal range of motion and excellent function; however, limited resections are acceptable in only in a small number of patients. In patients with malignant and recurrent lesions, wide resection is required, which is associated with significant limitations of shoulder function.
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Putnam AR, Standaert CJ. A rare cause of scapular pain. PM R 2012; 4:787-8. [PMID: 23093222 DOI: 10.1016/j.pmrj.2012.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 06/22/2012] [Indexed: 11/15/2022]
Affiliation(s)
- Alison R Putnam
- Department of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, WA 98195, USA.
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Tang X, Guo W, Yang R, Ji T, Sun X. Reconstruction with constrained prosthesis after total scapulectomy. J Shoulder Elbow Surg 2011; 20:1163-9. [PMID: 21524924 DOI: 10.1016/j.jse.2010.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 11/23/2010] [Accepted: 12/06/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Scapular prosthetic replacement after total scapulectomy can result in oncologic salvage and good postoperative function with a low rate of complications. MATERIALS AND METHODS Ten patients who underwent constrained scapular prosthetic replacement after total scapulectomy between 2003 and 2009 were reviewed retrospectively. RESULTS At a mean follow-up of 36 months, 2 patients died of their disease. One patient showed recurrence and metastasis. Complications, including dislocation and superficial wound infection, occurred in 2 patients. The mean Musculoskeletal Tumor Society 93 score was 23.2 of 30 points. High scores were achieved for most items except hand position; only 5 patients can raise their hands above their waist. The ranges of active shoulder abduction and forward flexion motion were 20° to 45° and 40° to 65°, respectively. All patients retained normal hand and elbow functions. CONCLUSION Although there are limitations in the shoulder's active motion, reconstruction with a scapular prosthesis can provide oncologic salvage and result in good postoperative function with a low rate of complications.
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Affiliation(s)
- Xiaodong Tang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
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El Mekkaoui M, Mahfoud M, El Bardouni A, Berrada M, El Yaacoubi M. El papel de la escapulectomía en el tratamiento de los tumores de la escápula: a propósito de 6 casos. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recot.2010.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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El Mekkaoui M, Mahfoud M, El Bardouni A, Berrada M, El Yaacoubi M. The role of scapulectomy in the care of the scapular tumors: a report of 6 cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/s1988-8856(11)70292-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Yang Q, Li J, Yang Z, Li X, Li Z. Limb sparing surgery for bone tumours of the shoulder girdle: the oncological and functional results. INTERNATIONAL ORTHOPAEDICS 2010; 34:869-75. [PMID: 19701633 PMCID: PMC2989017 DOI: 10.1007/s00264-009-0857-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 07/28/2009] [Accepted: 07/28/2009] [Indexed: 10/20/2022]
Abstract
It is a great challenge to spare the upper limb with a malignant or invasive benign bone tumour of the shoulder girdle. We retrospectively analysed 35 patients with bone tumours of the shoulder girdle treated with various limb salvage procedures. The tumours included 25 primary malignancies, three metastases and seven giant cell tumours which involved the proximal humerus in 21 patients, scapula in 12 and clavicle in two. The reconstruction procedures included eight prosthetic replacements, four devitalised tumorous bone grafts, three osteoarticular allografts, two autogenous fibular grafts, one intramedullary cemented nail, three Tikhoff-Linberg procedures, two replantation of shortened arms, and four humeral head suspensions. Six partial scapulectomies and two lateral clavicectomies needed no bone reconstruction. With an average follow-up of 71 months, local recurrences occurred in four cases and systemic metastases in six. Nine patients died and 23 remained disease free. The five year Kaplan-Meier survival rate of 28 patients with malignancies was 69.5%. The average Musculoskeletal Tumour Society (MSTS) functional score was 77% (range 40-100%) in all patients.
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Affiliation(s)
- Qiang Yang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 People’s Republic of China
| | - Jianmin Li
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 People’s Republic of China
| | - Zhiping Yang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 People’s Republic of China
| | - Xin Li
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 People’s Republic of China
| | - Zhenfeng Li
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 People’s Republic of China
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Uchida K, Negoro K, Nakajima H, Inukai T, Yayama T, Mwaka ES, Tanizawa T, Imamura Y, Baba H. Alveolar rhabdomyosarcoma arising from the infraspinatus muscle in a child treated with subtotal scapulectomy and chemoradiotherapy: a case study. J Shoulder Elbow Surg 2009; 18:e21-6. [PMID: 19559365 DOI: 10.1016/j.jse.2009.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 02/10/2009] [Accepted: 02/23/2009] [Indexed: 02/01/2023]
Affiliation(s)
- Kenzo Uchida
- Department of Orthopaedics and Rehabilitation Medicine, Fukui University Faculty of Medical Sciences, Fukui, Japan.
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20
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Griffin AM, Shaheen M, Bell RS, Wunder JS, Ferguson PC. Oncologic and functional outcome of scapular chondrosarcoma. Ann Surg Oncol 2008; 15:2250-6. [PMID: 18506534 DOI: 10.1245/s10434-008-9975-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 04/07/2008] [Accepted: 05/04/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND The scapula is a common site for chondrosarcoma to occur. There has been disagreement between recent studies documenting the oncologic outcomes in patients with chondrosarcoma of the scapula. The purpose of this study was to investigate both the oncologic and functional outcomes of patients presenting to a large oncology center with primary chondrosarcoma of the scapula. METHODS A review of our prospectively collected database was carried out. All patients in the years 1989 to 2004 undergoing surgical resection of primary chondrosarcoma of the scapula were included. We documented patient demographics, whether the patient underwent partial or total scapulectomy, oncologic outcomes including local and systemic recurrence, and functional outcome using the Musculoskeletal Tumor Society (MSTS) 87, MSTS 93, and Toronto Extremity Salvage Score (TESS) rating systems. RESULTS Twenty-four patients (16 males, 8 females), with a mean age of 44 years (range 18-74 years), met the inclusion criteria. There were no local recurrences. Two patients died of metastatic disease at 23 and 103 months postoperatively. No other patients have developed systemic disease. Sixteen patients underwent partial scapulectomy while eight underwent total scapulectomy. Functional outcome was better in the group undergoing partial scapulectomy with significantly higher MSTS 87 (30.8 versus 16.6), MSTS 93 (89.6 versus 68.3), and TESS (92.6 versus 74.9) scores than the total scapulectomy group. CONCLUSION Patients with primary chondrosarcoma of the scapula have an excellent oncologic prognosis with a very low local recurrence and metastatic rate. Functional outcomes are better for patients undergoing partial rather than total scapulectomy.
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Affiliation(s)
- Anthony M Griffin
- University Musculoskeletal Oncology Unit at Mount Sinai Hospital, The University of Toronto, Suite 476G, 600 University Avenue, Toronto, Canada
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21
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Mayil Vahanan N, Mohanlal P, Bose JC, Gangadharan R, Karthisundar V. The functional and oncological results after scapulectomy for scapular tumours: 2-16-year results. INTERNATIONAL ORTHOPAEDICS 2007; 31:831-6. [PMID: 17043860 PMCID: PMC2266659 DOI: 10.1007/s00264-006-0261-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 08/13/2006] [Accepted: 08/14/2006] [Indexed: 10/24/2022]
Abstract
Twenty-five patients underwent scapulectomy for various tumours between 1989 and 2005. We describe 23 patients with scapular tumours who were followed-up for a minimum of 2 years after scapulectomy. The average age was 29 years, and two-thirds of the patients were male. Nineteen patients had malignant neoplasms, of which chondrosarcoma was most common, followed by Ewing's sarcoma. Surgical staging was by Enneking's system, with stage IIB being the most frequent. Fifteen patients underwent total scapulectomy, and the rest had their glenoid retained. With an average follow-up period of 66.7 months (23-202 months), functional and oncological outcomes were evaluated for all patients. Two patients had superficial wound infections requiring antibiotics, and one had skin necrosis requiring skin cover. Functional outcome was satisfactory in 13 patients. Cosmetically and emotionally acceptable surgery, scapulectomy made 19 patients continuously disease free, while four patients died of disease. The 5-year survival rate of 19 patients with malignant tumours was 75.9%. Retention of the glenohumeral articulation (subtotal) resection gives superior functional results.
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Affiliation(s)
- N Mayil Vahanan
- Department of Orthopaedics & Trauma, Madras Medical College & Research Institute, Govt. General Hospital, Chennai, India.
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22
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Norton C, Drenen CM, Emms SG. Subtotal scapulectomy as the treatment for scapular tumour in the dog: a report of six cases. Aust Vet J 2007; 84:364-6. [PMID: 17359476 DOI: 10.1111/j.1751-0813.2006.00033.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The medical records of six dogs treated by sub-total scapulectomy for tumours involving the scapula were reviewed. The mean age of dogs in this study was 8 years and 4 months. Clinical signs on presentation included lameness of the affected forelimb and a palpable mass over the scapular area on physical examination. Pre-operative chest and affected forelimb radiographs were taken in most cases in addition to a biopsy. Subtotal scapulectomy was performed, ensuring margins clear of neoplastic tissue of at least 2 cm, preservation of the glenoid cavity and thus retention of the scapulo-humeral joint. On histopathological examination the tumours where diagnosed as chondrosarcoma (one), haemangiosarcoma (two), anaplastic malignant neoplasia (one) and osteosarcoma (one). Limb function was found to be good in all cases postoperatively. Prognosis was related to histopathological diagnosis of the tumour, favourable with chondrosarcoma and poor with the other tumour types.
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Affiliation(s)
- C Norton
- Camberwell Veterinary Clinic, Camberwell VIC 3124
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23
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Kiss J, Sztrinkai G, Antal I, Kiss J, Szendroi M. Functional results and quality of life after shoulder girdle resections in musculoskeletal tumors. J Shoulder Elbow Surg 2007; 16:273-9. [PMID: 17321167 DOI: 10.1016/j.jse.2006.08.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Revised: 07/28/2006] [Accepted: 08/09/2006] [Indexed: 02/01/2023]
Abstract
From 1981 to 2001, 91 shoulder resections were performed to treat shoulder girdle tumors (64 primary and 27 metastatic) in 90 patients (53 male and 37 female patients). The mean age was 34 years in patients with a primary tumor and 61 years in those with metastases. There were 7 partial scapulectomies, 13 total scapulectomies, 56 proximal humeral resections, 5 diaphyseal resections, 5 total shoulder girdle resections (Tikhoff-Linberg procedure), and 5 other procedures performed. Prosthesis implantation was carried out in 41 cases, autologous fibular transposition was done in 19, and massive homologous bone grafting was done in 4. Of the patients, 37 were clinically reviewed with a mean follow-up of 4.7 years (range, 1-20 years) by use of the recommendations of the Musculoskeletal Tumor Society for pain, function, position of hand, lifting ability, manual dexterity, and satisfaction. Nine patients were reviewed via a questionnaire and telephone interview. Twenty-six had died, and eighteen were lost to follow-up. The best results were achieved after partial scapulectomy and after humeral resection reconstructed with fibular transposition, when the function of the rotator cuff was preserved. After total scapulectomy and after humeral resection with the implantation of a tumor endoprosthesis, the function of the shoulder remained moderate because the rotator cuff was damaged. The overall satisfaction was generally good after all types of shoulder resections as a result of pain relief, preserved hand function, and improvement of psychological status. Patients can compensate extremely well by using the preserved joints and the contralateral upper limb; therefore, patient satisfaction does not rely on shoulder function alone.
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Affiliation(s)
- János Kiss
- Department of Orthopaedics, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Abstract
BACKGROUND Chondrosarcoma is the second most common primary sarcoma of bone. It often develops within flat bones, such as the pelvis, ribs, and scapula. In the current study, the authors reviewed the surgical experience and long-term oncologic outcomes of patients with chondrosarcoma arising in the scapula. METHODS The medical records of 29 consecutive patients with chondrosarcoma of the scapula were reviewed. The patients were treated between 1954 and 1994. All patients had localized disease at the time of presentation. The tumors were classified histologically as Grade 1 (10 patients), Grade 2 (10 patients), Grade 3 (7 patients), dedifferentiated (1 patient), and mesenchymal (1 patient) (using the criteria of Evans et al.). The mean maximal dimension of the tumors was 11 cm. Twenty-five patients underwent limb-sparing surgical resection and 4 patients underwent forequarter amputations. The median follow-up was 13 years (range, 1-35 years). RESULTS At last follow-up, 22 patients (76%) were free of disease and 7 patients (24%) had died of their disease. Local recurrence occurred in 4 patients at 7 months, 16 months, 40 months, and 43 months, respectively. The local recurrence-free survival rate was 86% at 5 years, 10 years, and 20 years. Disease-specific survival was 83% at 5 years, 74% at 10 years, and 74% at 20 years. Patients who had low-grade chondrosarcomas had better survival compared with patients who had high-grade chondrosarcomas (P = 0.07). CONCLUSIONS Patients who had localized chondrosarcoma of the scapula had a favorable long-term outcome, most likely due to the unique anatomic features that improved the likelihood of achieving wide surgical margins with limb-sparing surgery, despite the frequent presentation of locally advanced disease.
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Affiliation(s)
- Rajeev Pant
- Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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25
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Affiliation(s)
- Basil C Vrettos
- Nottingham Shoulder and Elbow Unit, Nottingham, United Kingdom
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Taira H, Yoshida S, Takasita M, Tsumura H, Torisu T. Limb salvage for malignant bone and soft-tissue tumours of the shoulder girdle. INTERNATIONAL ORTHOPAEDICS 2003; 27:136-40. [PMID: 12799755 PMCID: PMC3458446 DOI: 10.1007/s00264-002-0425-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2002] [Indexed: 10/25/2022]
Abstract
We treated 15 patients with malignant bone and soft-tissue tumours of the shoulder girdle using limb salvage operations involving resection of the proximal humerus, scapula and clavicle. The oncological and functional outcomes were evaluated in all patients after an average of 5 (1-13) years. Oncological evaluation revealed that in 11 patients with adequate surgical margins six were continuously disease free and two had no evidence of disease. Three patients with marginal surgical margins had all died. We suggest that only where adequate surgical margins can be obtained should operations be performed. Forequarter amputation is still indicated in patients with complicated neurovascular involvement. Functional evaluation showed that scapular resections, especially glenoid resections, provided poor results (mean score 54%) in comparison with patients without such resection (mean score 82%).
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Affiliation(s)
- Hirofumi Taira
- Department of Orthopaedic Surgery, Oita Medical University, 1-1 idaiga-oka, Hasama-machi, Oita-gun, Oita, Japan.
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Bickels J, Wittig JC, Kollender Y, Kellar-Graney K, Meller I, Malawer MM. Limb-sparing resections of the shoulder girdle. J Am Coll Surg 2002; 194:422-35. [PMID: 11949748 DOI: 10.1016/s1072-7515(02)01124-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Limb-sparing surgeries around the shoulder girdle pose a surgical difficulty, because tumors arising in this location are frequently large at presentation, are juxtaposed to the neurovascular bundle, require en bloc resection of proportionally large amounts of bone and soft tissues, and necessitate complex resection and reconstruction. STUDY DESIGN Between 1980 and 1997, we treated 134 patients who presented with 110 primary malignant, 12 metastatic, and 12 benign aggressive bone and soft tissue tumors of the shoulder girdle and subsequently underwent a limb-sparing resection. Reconstruction of the bone defect included 92 proximal humerus and 9 scapular prostheses. All patients were followed up for a minimum of 2 years. We summarize the principles of limb-sparing resections of the shoulder girdle, with emphasis on the surgical anatomy of the shoulder girdle, principles of resection and reconstruction, and functional outcomes. RESULTS Function was estimated to be good or excellent in 101 patients (75.4%), moderate in 23 patients (17.1%), and poor in 10 patients (7.5%). Complications included 13 transient nerve palsies, 2 deep wound infections, and 1 prosthetic loosening. Local tumor recurrence occurred in 5 of 103 (4.9%) patients with primary sarcomas of the shoulder girdle. CONCLUSIONS Detailed preoperative evaluation and surgical planning are essential for performing a limb-sparing resection around the shoulder girdle. Local tumor control, associated with good functional outcomes, is achieved in the majority of patients.
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Affiliation(s)
- Jacob Bickels
- Department of Orthopedic Oncology, Washington Cancer Institute, Washington Hospital Center, George Washington University, Washington, DC 20010, USA
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Bertucio CS, Wara WM, Matthay KK, Ablin AR, Johnston JO, O'Donnell RJ, Weinberg V, Haas-Kogan DA. Functional and clinical outcomes of limb-sparing therapy for pediatric extremity sarcomas. Int J Radiat Oncol Biol Phys 2001; 49:763-9. [PMID: 11172960 DOI: 10.1016/s0360-3016(00)01415-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine the clinical and functional outcomes of children undergoing limb-sparing therapy for extremity sarcomas. METHODS AND MATERIALS We retrospectively reviewed 30 patients, age < or = 21 years, who were treated between l979 and l998 with external beam radiotherapy as a component of limb-sparing therapy for primary sarcomas of the extremity at UCSF. Included were patients for whom complete follow-up and functional outcome assessments were available. We assessed the patterns of failure, overall survival, disease-free survival, local control, and limb function. RESULTS At a median follow-up of 3 years, 12 of the 30 patients recurred: 3 locally, 8 distantly, and 1 with synchronous local and distant disease as site of first progression. Eighteen patients were alive with no evidence of disease. The median overall survival was 10 years, with a median disease-free survival of 8 years. Functional outcome assessment revealed 15 patients retained excellent, 12 good, 1 fair, and 2 poor limb function. CONCLUSION In pediatric patients receiving limb-sparing therapy, 90% maintained excellent or good limb function without compromising survival, demonstrating the validity of limb preservation in children with extremity sarcomas.
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Affiliation(s)
- C S Bertucio
- Department of Radiation Oncology, University of California-San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0226, USA
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Affiliation(s)
- M F Blacksin
- Department of Radiology, University of Medicine and Dentistry of New Jersey, University Hospital, Newark 07103-2426, USA
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