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Angelini A, Tiengo C, Cerchiaro MC, Soto F, Biz C, Messana F, Bassetto F, Ruggieri P. Ortho-oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft-tissue defects after oncologic resections. Microsurgery 2024; 44:e31168. [PMID: 38549392 DOI: 10.1002/micr.31168] [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: 03/18/2023] [Revised: 01/20/2024] [Accepted: 02/28/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Malignant tumors of the foot are rare, and treatment strategies are challenging considering the complex anatomy of this area. In recent years, dramatic advances in technology and collaborations between different specialties (such as orthopedic, oncology, radiology, plastic, and vascular surgery) significantly changed the approach to complex malignant tumors without resorting to limb removal. The combination of the strengths of both orthopedic surgery and plastic surgery constitutes the modern definition of "orthoplasty." The aim of this review article is to provide treatment strategies that are available for reconstruction of foot and ankle in limb-salvage surgery after tumor resection, with a specific focus on microsurgical techniques in plastic surgery. METHODS We conducted a comprehensive search for relevant papers across PubMed, Scopus, Embase, and Web of Science. We included patient-based studies reporting on procedures for soft-tissue reconstruction with small and large soft tissue defects. Indications, pros and cons, and technique tips are discussed for each type of reconstructive technique. RESULTS The search was done using literature of the past 30 years (from 1990 to date), resulting in about 725 articles describing over 2000 cases. Cutaneous flaps included lateral supramalleolar flap, medial plantar flap, reverse sural neurocutaneous island flap, medial leg flap, and lateral leg flap. Free flaps included anterolateral thigh flap, radial forearm flap, latissimus dorsi flap, gracilis muscle flap, lateral arm flap, and rectus abdominis flap. CONCLUSIONS The orthoplastic approach in musculoskeletal oncology is a collaborative model of orthopedic and plastic surgeons working together, resulting in a higher rate of successful limb salvage in patients at risk for amputation. Protocols, biologic substitutes, and surgical techniques are largely improved in the last decades increasing the possibility of functional reconstruction. Microsurgical strategies represent the new frontiers in these demanding reconstructions.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | - Cesare Tiengo
- Department of Plastic surgery, University of Padua, Padova, Italy
| | | | - Fernando Soto
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | - Carlo Biz
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | | | - Franco Bassetto
- Department of Plastic surgery, University of Padua, Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
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Machado PAB, Bartolomeu GFP, Handeri AM, Silva MOT, Hirsch AE, Drummond-Lage AP. Assessment of medical students' knowledge of primary limb sarcomas. BMC MEDICAL EDUCATION 2024; 24:138. [PMID: 38350994 PMCID: PMC10863214 DOI: 10.1186/s12909-024-05111-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Typically, oncology is not a structured part of the curriculum in Brazilian medical schools. Furthermore, sarcomas, which are uncommon tumors, are seldom covered in depth. A lack of comprehensive education on sarcomas might result in medical professionals being ill-equipped to care for patients with this condition. OBJECTIVES To assess medical students' understanding and awareness of sarcomas and the specific principles related to these tumors. MATERIALS AND METHODS A quantitative, cross-sectional study was conducted using a questionnaire, applied to medical students, focusing on the epidemiology, pathophysiology, and treatments of bone and soft tissue sarcomas. In all tests, the significance level adopted was 5%. The SPSS version 25.0 software was used. RESULTS Of the 825 questionnaires distributed, 325 were returned. Educational sessions on sarcomas did not appear to significantly improve the student's knowledge. Only 29.5% of students identified the lack of pain as an indicator of potential malignancy in soft tissue sarcomas, while 73.8% correctly recognized pain as a symptom of bone sarcomas. Limb amputation as the optimal surgical method for patient recovery was incorrectly reported by 39.1% of the sample. CONCLUSION A great part of the surveyed population does not have adequate knowledge about the basic concepts associated with limb sarcomas. The minority of them are satisfied with the knowledge gained during their medical education about these tumors. Inadequate medical academic training may initially lead to the wrong clinical management of patients with bone and soft tissue tumor lesions. An educational effort is needed to enhance oncology education for medical students, especially concerning sarcomas.
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Affiliation(s)
| | | | | | | | - Ariel E Hirsch
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ana Paula Drummond-Lage
- Post Graduation Department, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.
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Blank A, Fice MP. Challenges in the Management of Complex Soft-Tissue Sarcoma Clinical Scenarios. J Am Acad Orthop Surg 2024; 32:e115-e124. [PMID: 37852242 DOI: 10.5435/jaaos-d-22-00865] [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] [Received: 09/21/2022] [Accepted: 09/06/2023] [Indexed: 10/20/2023] Open
Abstract
With nearly 15,000 new cases of soft-tissue sarcoma (STS) in the United States each year, early diagnosis and therapeutic management is imperative for successful patient outcomes. Primary STS is conventionally treated with a combination of wide-margin resection, neoadjuvant or adjuvant radiation therapy, and, in specific cases, adjuvant chemotherapy. However, in situations of complex disease presentation, guidelines for treatment are less clearly outlined. Limited metastatic disease, local recurrence, fungating STSs, and unplanned or incomplete resections of STSs present unique challenges for the multidisciplinary care team. The management of complex STS clinical scenarios usually involves limb-salvage resection or amputation as well as some combination of radiation therapy and/or ablative interventional radiology techniques. As a result, a multidisciplinary team approach is essential for treating patients in these challenging scenarios, with a recent focus on the integration of plastic and reconstructive surgery into the treatment algorithm.
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Affiliation(s)
- Alan Blank
- From the Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL
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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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Angelini A, Biz C, Cerchiaro M, Longhi V, Ruggieri P. Malignant Bone and Soft Tissue Lesions of the Foot. J Clin Med 2023; 12:3038. [PMID: 37109375 PMCID: PMC10146676 DOI: 10.3390/jcm12083038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/07/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Malignant tumors of the foot are rare pathologies that can involve the skin, soft tissue, or bone. Due to their rarity, they are often misdiagnosed, resulting in inadequate excision and poor outcomes. A correct approach with a careful examination and radiological study, followed by a properly performed biopsy, is thus mandatory to avoid these pitfalls. The present article reviews the most common malignant bone and soft tissue lesions of the foot region, discussing their clinicopathological presentation, imaging features, and current concepts in treatment.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy (P.R.)
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Wiffen J, Mah E. Determining functional outcomes after resection and reconstruction of primary soft tissue sarcoma in the lower extremity: A review of current subjective and objective measurement systems. J Surg Oncol 2023; 127:862-870. [PMID: 36683344 DOI: 10.1002/jso.27202] [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: 07/06/2022] [Revised: 11/27/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
The surgical management of soft-tissue sarcoma has evolved significantly over the last two decades due to the routine use of adjunct therapies, with an increased focus on postoperative functional outcome. The literature suffers from methodological inconsistency and use of low quality outcome measures to assess an already heterogeneous population. This article aims to review the most frequently used subjective and objective methods of functional outcome assessment and highlight the current benefits and limitations of these.
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Affiliation(s)
- James Wiffen
- St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Eldon Mah
- Department of Plastic & Reconstructive Surgery, St Vincent's Hospital, Melbourne, Australia
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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: 13] [Impact Index Per Article: 13.0] [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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9
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Geiger EJ, Liu W, Srivastava DK, Bernthal NM, Weil BR, Yasui Y, Ness KK, Krull KR, Goldsby RE, Oeffinger KC, Robison LL, Dieffenbach BV, Weldon CB, Gebhardt MC, Howell R, Murphy AJ, Leisenring WM, Armstrong GT, Chow EJ, Wustrack RL. What Are Risk Factors for and Outcomes of Late Amputation After Treatment for Lower Extremity Sarcoma: A Childhood Cancer Survivor Study Report. Clin Orthop Relat Res 2023; 481:526-538. [PMID: 35583517 PMCID: PMC9928620 DOI: 10.1097/corr.0000000000002243] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although pediatric lower extremity sarcoma once was routinely treated with amputation, multiagent chemotherapy as well as the evolution of tumor resection and reconstruction techniques have enabled the wide adoption of limb salvage surgery (LSS). Even though infection and tumor recurrence are established risk factors for early amputation (< 5 years) after LSS, the frequency of and factors associated with late amputation (≥ 5 years from diagnosis) in children with sarcomas are not known. Additionally, the resulting psychosocial and physical outcomes of these patients compared with those treated with primary amputation or LSS that was not complicated by subsequent amputation are not well studied. Studying these outcomes is critical to enhancing the quality of life of patients with sarcomas. QUESTIONS/PURPOSES (1) How have treatments changed over time in patients with lower extremity sarcoma who are included in the Childhood Cancer Survivor Study (CCSS), and did primary treatment with amputation or LSS affect overall survival at 25 years among patients who had survived at least 5 years from diagnosis? (2) What is the cumulative incidence of amputation after LSS for patients diagnosed with pediatric lower extremity sarcomas 25 years after diagnosis? (3) What are the factors associated with time to late amputation (≥ 5 years after diagnosis) in patients initially treated with LSS for lower extremity sarcomas in the CCSS? (4) What are the comparative social, physical, and emotional health-related quality of life (HRQOL) outcomes among patients with sarcoma treated with primary amputation, LSS without amputation, or LSS complicated by late amputation, as assessed by CCSS follow-up questionnaires, the SF-36, and the Brief Symptom Inventory-18 at 20 years after cancer diagnosis? METHODS The CCSS is a long-term follow-up study that began in 1994 and is coordinated through St. Jude Children's Research Hospital. It is a retrospective study with longitudinal follow-up of more than 38,000 participants treated for childhood cancer when younger than 21 years at one of 31 collaborating institutions between 1970 and 1999 in the United States and Canada. Participants were eligible for enrollment in the CCSS after they had survived 5 years from diagnosis. Within the CCSS cohort, we included participants who had a diagnosis of lower extremity sarcoma treated with primary amputation (547 patients with a mean age at diagnosis of 13 ± 4 years) or primary LSS (510 patients with a mean age 14 ± 4 years). The LSS cohort was subdivided into LSS without amputation, defined as primary LSS without amputation at the time of latest follow-up; LSS with early amputation, defined as LSS complicated by amputation occurring less than 5 years from diagnosis; or LSS with late amputation, defined as primary LSS in study patients who subsequently underwent amputation 5 years or more from cancer diagnosis. The cumulative incidence of late amputation after primary LSS was estimated. Cox proportional hazards regression with time-varying covariates identified factors associated with late amputation. Modified Poisson regression models were used to compare psychosocial, physical, and HRQOL outcomes among patients treated with primary amputation, LSS without amputation, or LSS complicated by late amputation using validated surveys. RESULTS More study participants were treated with LSS than with primary amputation in more recent decades. The overall survival at 25 years in this population who survived 5 years from diagnosis was not different between those treated with primary amputation (87% [95% confidence interval [CI] 82% to 91%]) compared with LSS (88% [95% CI 85% to 91%]; p = 0.31). The cumulative incidence of amputation at 25 years after cancer diagnosis and primary LSS was 18% (95% CI 14% to 21%). With the numbers available, the cumulative incidence of late amputation was not different among study patients treated in the 1970s (27% [95% CI 15% to 38%]) versus the 1980s and 1990s (19% [95% CI 13% to 25%] and 15% [95% CI 10% to 19%], respectively; p = 0.15). After controlling for gender, medical and surgical treatment variables, cancer recurrence, and chronic health conditions, gender (hazard ratio [HR] 2.02 [95% CI 1.07 to 3.82]; p = 0.03) and history of prosthetic joint reconstruction (HR 2.58 [95% CI 1.37 to 4.84]; p = 0.003) were associated with an increased likelihood of late amputation. Study patients treated with a primary amputation (relative risk [RR] 2.04 [95% CI 1.15 to 3.64]) and LSS complicated by late amputation (relative risk [RR] 3.85 [95% CI 1.66 to 8.92]) were more likely to be unemployed or unable to attend school than patients treated with LSS without amputation to date. The CCSS cohort treated with primary amputation and those with LSS complicated by late amputation reported worse physical health scores than those without amputation to date, although mental and emotional health outcomes did not differ between the groups. CONCLUSION There is a substantial risk of late amputation after LSS, and both primary and late amputation status are associated with decreased physical HRQOL outcomes. Children treated for sarcoma who survive into adulthood after primary amputation and those who undergo late amputation after LSS may benefit from interventions focused on improving physical function and reaching educational and employment milestones. Efforts to improve the physical function of people who have undergone amputation either through prosthetic design or integration into the residuum should be supported. Understanding factors associated with late amputation in the setting of more modern surgical approaches and implants will help surgeons more effectively manage patient expectations and adjust practice to mitigate these risks over the life of the patient. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Erik J. Geiger
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, CA, USA
| | - Wei Liu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nicholas M. Bernthal
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, CA, USA
| | - Brent R. Weil
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Robert E. Goldsby
- Division of Oncology, Department of Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
| | - Kevin C. Oeffinger
- Department of Medicine and Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Bryan V. Dieffenbach
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Christopher B. Weldon
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Department of Surgery and Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Mark C. Gebhardt
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Rebecca Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J. Murphy
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Wendy M. Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Eric J. Chow
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rosanna L. Wustrack
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
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Xu H, Li Y, Yu F, Liu W, Hao L, Zhang Q, Niu X. GMRS Oncological Prosthesis with a Porous Coating Collar: A Good Option for Revision of Aseptic Loosening in the Lower Extremity. J Clin Med 2023; 12:jcm12030892. [PMID: 36769540 PMCID: PMC9918170 DOI: 10.3390/jcm12030892] [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] [Received: 11/13/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Revisions for oncological prosthesis are especially challenging due to the limited bone quantity and poor quality that the patients still possess. The aims of this study were to ask (1) what is the cumulative survival of the Global Modular Replacement System (GMRS) prosthesis after revision? and (2) what are the long-term functional outcomes of these patients? METHODS We retrospectively reviewed 16 patients who developed aseptic loosening of a lower extremity prosthesis. There were nine males and seven females with a mean age of 28 years (range, 14-55 years). The 5-year and 8-year survivorship of the prosthesis were calculated. Function outcome was evaluated according to the score of the Musculoskeletal Tumor Society (MSTS). RESULTS At a mean of 90 months follow-up (range, 52-118 months), the cumulative survival of all revision prosthesis was 94% at both 5 and 8 years. There were two prosthesis failures including one infection and one repeated aseptic loosening. At the last follow-up, except for the infection case, 93.3% (14/15) of the patients did not develop repeated aseptic loosening. The mean MSTS score was 27.7 (range, 24-30). CONCLUSIONS GMRS prosthesis demonstrated significant satisfactory long-term outcomes for revisions of lower extremity oncological prosthesis.
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Affiliation(s)
| | | | | | | | | | | | - Xiaohui Niu
- Correspondence: ; Tel.: +86-10-58516506; Fax: +86-10-58516736
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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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12
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Koulaxouzidis G, Schlagnitweit P, Anderl C, Braig D, Märdian S. Microsurgical Reconstruction in Orthopedic Tumor Resections as Part of a Multidisciplinary Surgical Approach for Sarcomas of the Extremities. Life (Basel) 2022; 12:1801. [PMID: 36362956 PMCID: PMC9695779 DOI: 10.3390/life12111801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2023] Open
Abstract
A central element of modern sarcoma therapy is complete surgical tumor resection with an adequate safety margin, embedded in an interdisciplinary multimodal therapy concept. Along with ensuring patient survival, functional limb preservation is an important goal for sarcomas of the extremities. This review provides an overview of the relevant literature on indications and goals of reconstructive options, the scope and contribution of microsurgical reconstructive procedures, and the associated interdisciplinary decision making and workup. Furthermore, the impact of (neo)-adjuvant therapy on reconstructive decisions will be highlighted. These aspects will be illustrated by four comprehensive case studies that demonstrate both useful strategies and the need for individually tailored therapies. Nowadays, extremity-preserving therapy is possible in more than 90% of sarcomas. Technical and procedural innovations such as microsurgery and microsurgical reconstructive procedures have significantly contributed to this evolution of therapy.
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Affiliation(s)
- Georgios Koulaxouzidis
- Department of Plastic, Aesthetic and Reconstructive Surgery, Congregational Hospital Linz, Sisters of Mercy, 4010 Linz, Austria
| | - Paul Schlagnitweit
- Department of Plastic, Aesthetic and Reconstructive Surgery, Congregational Hospital Linz, Sisters of Mercy, 4010 Linz, Austria
| | - Conrad Anderl
- Department of Orthopaedic Surgery, Congregational Hospital Linz, Sisters of Mercy, 4010 Linz, Austria
| | - David Braig
- Department of Plastic and Hand Surgery, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University of Munich, 80336 Munich, Germany
| | - Sven Märdian
- Centre for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Insitute of Health, 13353 Berlin, Germany
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Bartelstein MK, Boland PJ. Fifty years of bone tumors. J Surg Oncol 2022; 126:906-912. [PMID: 36087079 PMCID: PMC9524618 DOI: 10.1002/jso.27027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022]
Abstract
There have been enormous advances in the treatment of bone tumors over the past half-century. The most notable of these has been the transition from amputation as the standard of care to limb salvage surgery. This transition is the result of advances in imaging techniques, accurate diagnosis, systemic therapies (including chemotherapy), and prosthetic design for the reconstruction of musculoskeletal defects. Advances have also been made in the management of benign and metastatic bone tumors.
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Affiliation(s)
- Meredith K. Bartelstein
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patrick J. Boland
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Arjunan R, Dharanikota A, Chowdappa R, Althaf S, Dasappa A, Shetty NS. Impact of Level of Surgery on the Functional Outcomes in Patients with Lower Extremity Bone Tumors Undergoing Amputation Versus Limb Salvage Surgery. Indian J Surg Oncol 2022. [DOI: 10.1007/s13193-022-01627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Yu XJ, Liu QK, Wang YG, Wang SX, Lu R, Xu HR, Wan JL, Kang H. Oncologic and functional outcomes of different reconstruction modalities after resection of chondrosarcoma of the scapula: a medium- to long-term follow-up study. BMC Musculoskelet Disord 2022; 23:758. [PMID: 35941682 PMCID: PMC9358882 DOI: 10.1186/s12891-022-05661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives To evaluate the oncologic and functional results of scapular reconstruction after partial or total scapulectomy for chondrosarcoma. Materials and methods Twenty-one patients with chondrosarcoma who underwent partial or total scapulectomy between January 2005 and July 2019 were reviewed retrospectively. Results At a mean follow-up of 62.6 months (range, 13–123 months), four patients developed local recurrence, and three developed distant metastases, one of which developed both recurrence and metastasis. The overall survival rate of patients at 5 years was 84.6%, the disease-free survival rate was 69.3%, and the complication rate was 19% (4/21). The 1993 American Musculoskeletal Tumor Society (MSTS93) scores of patients in the partial scapulectomy group, total scapulectomy + humeral suspension group and prosthetic reconstruction group were 26.50 ± 1.38, 19.00 ± 2.58, and 21.38 ± 2.62, respectively. There was a statistically significant difference between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group ( P = 0.006 and 0.0336, respectively). The range of motion of the shoulder joint for forward flexion was 80.83° ± 11.14°, 51.25° ± 21.36°, and 52.50° ± 11.02°, respectively. The p-values for the comparison between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group were 0.0493 and 0.0174, respectively. And the range of motion of abduction was 75.00° ± 10.49°, 32.50° ± 11.90°, 41.88° ± 11.63°, respectively. Patients in the partial scapulectomy group had significantly better postoperative shoulder abduction function than the total scapulectomy + humeral suspension or prosthetic reconstruction group (P = 0.0035 and 0.0304, respectively). There was no significant difference in MSTS93 scores and flexion and abduction function of the shoulder joint in the upper extremity after total scapulectomy with humeral suspension or prosthetic reconstruction (P > 0.05). Conclusions Surgical treatment of chondrosarcoma of the scapula can achieve a satisfactory prognosis and shoulder function. Total scapulectomy followed by prosthetic reconstruction or humeral suspension are both feasible treatments. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05661-7. Surgical treatment of chondrosarcoma of the scapula can achieve good oncologic and functional outcomes. Prosthetic reconstruction of the scapula after scapulectomy does not provide better functional results than humeral suspension, and both are feasible treatment modalities.
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Affiliation(s)
- Xiao-Jun Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Qi-Kun Liu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Ying-Guang Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Shan-Xi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Rui Lu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Hao-Ran Xu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Jun-Lai Wan
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Hao Kang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China.
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Hudson T, Burke C, Mullner D, Herrera FA. Risk factors associated with 30-day complications following lower extremity sarcoma surgery: A national surgical quality improvement project analysis. J Surg Oncol 2022; 126:1253-1262. [PMID: 35856569 DOI: 10.1002/jso.27018] [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: 06/18/2022] [Accepted: 07/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Our study aims to identify risk factors associated with complications in lower extremity (LE) sarcoma surgery, as well as the prevalence and complications associated with concurrent plastic surgery procedures (CPSP). METHODS ACS-NSQIP database was accessed to identify patients treated for LE sarcoma (2010-2019). Patient demographics, preoperative lab, comorbidities, tumor type, location, principle procedure, and presence/characteristics of CPSPs were recorded. Thirty-day soft tissue complications were analyzed. Bivariate and multivariate logistic regression was performed on IBM SPSS.™ RESULTS: Nine hundred eighteen patients were included (483 males and 435 females), average age and body mass index (BMI) of 57 and 27.4 kg/m,2 respectively. Comorbidities included smoking (13.9%, 128), hypertension (37.3%, 342), and insulin-dependent diabetes (3.7%, 34). Preoperative lab values included albumin <3.5 (6.8%, 63), hematocrit <30% (8.2%, 75), and platelet count <150 000 (5.9%, 54). Thirty-day soft tissue complication rate was 5.7% (52 of 918). On multivariate logistic regression, increased age (p = 0.039), higher BMI (p = 0.017), and longer operative times (p = 0.002) were significant risk factors independently associated with soft tissue complications. CONCLUSIONS Soft tissue complications within 30 days occur in 6% of patients. Graft procedures carry a 20% risk of complications. Risk factors independently associated with complications include increased age, increased BMI, and longer operative times.
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Affiliation(s)
- Todd Hudson
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Division of Plastic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Connor Burke
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Donna Mullner
- Division of Plastic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Fernando A Herrera
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Division of Plastic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Hofer C, Trost C, Döring K, Kelaridis T, Windhager R, Hobusch GM. What sports activity levels can be achieved in the long-term after major lower extremity amputation for malignant tumors? - A minimum follow-up of twenty years. Orthop Traumatol Surg Res 2022; 108:103229. [PMID: 35123033 DOI: 10.1016/j.otsr.2022.103229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND It is well-known that exercise through sports and physical activity has beneficial effects on health. After lower extremity amputation, low rates of participation in sports activities have been shown. So far, there is only limited scientific long-term information concerning sports activity and feasible types of sports in patients with lower extremity amputations due to malignant tumors. This study sought to provide very long-term information about the following questions: (1) What sports activity levels can be achieved after lower extremity amputation due to a malignant tumor? (2) What are feasible types of sports? (3) Is the University of California Los Angeles (UCLA) Activity Score influenced by patient's age, the age at the time of surgery and the amount of prosthesis sockets used to date? HYPOTHESIS Patients with lower extremity amputation due to a malignant tumor cannot regularly participate in moderate sports activities (UCLA Activity Score≥6) in the very long-term. MATERIALS AND METHODS In a retrospective questionnaire survey, 21 former patients (seven females, 14 males; median age: 60.5years [range: 33-74]) who underwent an amputation of the lower extremity (14 transfemoral, four knee disarticulations, three transtibial) from 1961 to 1993 due to a malignant tumor were interviewed. The median follow-up was 41.1years (range: 23-55). The patients were interviewed about types of sports, frequencies and durations of sports sessions at the time of the last follow-up, as well as retrospectively. Sports activity levels were then assessed based on the UCLA Activity Score. Demographic background, data on amputation level, histological results, prosthetic devices and revision surgeries were collected. RESULTS Seven patients (33%) were still regularly exercising at least moderate sports activities at the last follow-up, including one patient regularly participating in impact sports. The preoperative median UCLA Activity Score of 9 (range: 2-10) decreased to 5 (range: 2-10) at the last follow-up (p<0.001). Swimming (13 patients, seven on a regular basis), cycling (seven), downhill skiing (five) and hiking (four) were among the most common feasible types of sports. Increasing age had a negative influence on the UCLA Activity Score [95% CI (-0.034, -0.006); RB=-0.020; SD=0.0074; p=0.007]. CONCLUSION After a major amputation in the lower extremity due to a malignant tumor, high activity levels by practicing types of sports such as downhill skiing, are achievable. In the very long-term, a regular participation in at least moderate activities, such as swimming, is possible. Programs for physical and sports activities, based on recommendations drawn from long-term experience, are necessary and should be individually tailored to amputees and their limitations. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Christoph Hofer
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Carmen Trost
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Kevin Döring
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Reinhard Windhager
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard M Hobusch
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
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18
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García-Ortega DY, Álvarez-Cano A, Clara-Altamirano MA, Caro-Sánchez C, Ruvalcaba-González CDLC, Cortés-González CC, Luna-Ortiz K. Bone invasion in soft tissue sarcomas of the extremities: An underappreciated prognostic factor. Bone invasion in soft tissue sarcomas. Surg Oncol 2021; 40:101692. [PMID: 34864631 DOI: 10.1016/j.suronc.2021.101692] [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: 09/09/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Bone invasion is unfrequently reported in soft tissue sarcomas of the extremities (eSTS), it is difficult to assess preoperatively and its prognostic impact has not been extensively studied. The objective of this paper was to analyze the incidence and the clinical impact of histologically proven bone invasion in individuals with eSTS. METHODS A retrospective analysis was performed using the medical files patients who had eSTS and were treated between 2012 and 2016. A 5 years survival was estimated using the Kaplan-Meier method and a Cox proportional risk assessment. The outcomes of patients with and without bone invasion were compared. RESULTS 370 patients were included in the analysis. The median follow up was 25 months, the median age was 45 years (IQR 31-58). Bone invasion was found in 41 (11.08%). Median tumor size was 11.8 cm. The majority of individuals were diagnosed at stage IV (n = 116, 31.4%), followed by stage IIIB (n = 87, 23.5%). High histological grade was associated with worse OS (HR 2.23, CI 95% 1.36-3.65, p = 0.001). Absence of bone invasion was associated with better prognosis (HR 0.541, CI 95% 0.34-0.86, p = 0.009). OS was 27.3 vs 49.28 months. The disease-free survival (DFS) was 25.1 in bone invasion vs 45.23 without bone invasion. CONCLUSION Bone invasion in individuals with eSTS is an independent adverse prognostic factor associated with lower OS and DFS; although infrequently reported, bone invasion might be considered as part of the staging in the future.
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Affiliation(s)
| | | | | | | | | | | | - Kuauhyama Luna-Ortiz
- Department of Head and Neck Surgery Department. National Cancer Institute, Mexico City, Mexico
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19
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Amputation for Extremity Sarcoma: Indications and Outcomes. Cancers (Basel) 2021; 13:cancers13205125. [PMID: 34680274 PMCID: PMC8533806 DOI: 10.3390/cancers13205125] [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: 08/22/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary Sarcomas are malignant tumors of soft tissues or bone. While limb salvage surgery (LSS) is the standard treatment, amputation is an option especially in local recurrence (LR) or complications after LSS. Two groups with primary amputations (n = 120) or secondary amputations after failed LSS due to LR or complications (n = 29) were compared. Five-year LR-free survival was 84% and 17 (16%) patients developed LR, of which 16 were in group I and only one in group II. Overall survival (OS) at five years was 44%, and the rate was identical in both groups. In those group II patients who had a secondary amputation after LSS due to contaminated margins or LR (n = 12) five-year OS was 33% compared to 48% in patients with complications (n = 17). This study indicates the worse oncological outcomes with respect to OS of sarcoma patients needing an amputation as compared to LSS. Patients with primary amputation or those who had a secondary amputation after failed LSS for whatever reason showed the same results. Abstract Background: Sarcomas are rare, malignant tumors of soft tissues or bone. Limb salvage surgery (LSS) is the standard treatment, but amputation is still an option, especially in local recurrence or complications after LSS. Methods: We retrospectively reviewed indications and oncological outcomes in patients who underwent an amputation. Two groups with either primary amputations (n = 120) or with secondary amputations after failed LSS with local recurrence or complications (n = 29) were compared with the main end points of LRFS and OS. Results: Five-year LRFS was 84% with 17 (16%) patients developing local recurrence, of which 16 (13%) occurred in group I. Forty-two (28%) patients developed metastatic disease and overall survival at five years was 44%. Overall survival (OS) was the same in both groups. In those group II patients who had a secondary amputation due to LR or insufficient margins after LSS (n = 12) the five-year OS was 33% compared to 48% in patients with amputation due to complications (n = 17) (n.s.). Conclusions: This study indicates the worse oncological outcomes with respect to OS of sarcoma patients requiring an amputation as compared to LSS. Patients with primary amputation or those who had a secondary amputation after failed LSS for whatever reason showed the same oncological results.
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Socioeconomic factors associated with limb salvage versus amputation for adult extremity bone sarcomas in patients with insurance coverage. Surg Oncol 2021; 39:101664. [PMID: 34571448 DOI: 10.1016/j.suronc.2021.101664] [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: 05/28/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Limb salvage (LS) has become the preferred treatment for adult patients with bone sarcoma of the extremities. The decision to perform LS versus an amputation is often dictated by tumor characteristics, however there may be socioeconomic factors associated with LS. Previously this has been linked to insurance status, however currently there is a paucity of data examining socioeconomic factors in patients with medical insurance at the time of sarcoma diagnosis. Therefore, the purpose of the current study was to examine socioeconomic factors which could be associated with the decision to perform LS versus amputation for adult bone sarcoma patients. METHODS Data from Optum Labs Data Warehouse, a national administrative claims database, was analyzed to identify patients with extremity bone sarcomas from 2006 to 2017. Bivariate regression was used to identify factors associated with LS versus amputation. RESULTS Of 1,390 (743 males, 647 female) patients, 252 (18%) under amputation while 1,138 (82%) underwent LS. Lower extremity tumors (OR 4.72, p < 0.001), income <$75,000 (OR 1.85, p = 0.03), being treated a public hospital (OR 1.41, p = 0.04) and a hospital with <200 beds (OR 1.90, p = 0.006) were associated with amputation. Income ≥$125,000 (OR 0.62, 0.04) were associated with LS. CONCLUSION In adult patients with medical insurance at the time of diagnosis, socioeconomic and hospital factors were associated with an amputation for bone sarcoma, with poorer patients, and those treated at smaller, and public hospitals more likely to undergo amputation.
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21
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Wang Y, Mai H, Yuan Y, Chen H, Wu S, Hu X, Yu A. EWS-FLI1-targeting peptide identifies Ewing sarcoma tumor boundaries and lymph node metastasis via near-infrared imaging. Mol Oncol 2021; 15:3706-3720. [PMID: 34392592 PMCID: PMC8637573 DOI: 10.1002/1878-0261.13081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022] Open
Abstract
Ewing sarcoma (ES) is one of the most aggressive types of pediatric tumors. The lack of tools for the identification of ES has largely hindered clinical diagnosis and the improvement of treatment. To address this challenge, we synthesized a near‐infrared (NIR) fluorescent probe (CS2‐N‐E9R) that targets the ES‐specific fusion protein EWS–FLI1 (E/F). This probe exhibited specific and high binding affinity to E/F. Further studies in animal models showed that CS2‐N‐E9R can be used to identify the boundaries of ES and lymph node metastases under a complex biological environment. These results demonstrate that CS2‐N‐E9R is a promising probe for early diagnosis and surgical guidance of ES through molecularly targeted NIR imaging.
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Affiliation(s)
- Yu Wang
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, China
| | - Hengtang Mai
- Hubei Province Engineering and Technology Research Center for Fluorinated Pharmaceuticals, School of Pharmaceutical Sciences, Wuhan University, China
| | - Ying Yuan
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, China
| | - Hairen Chen
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, China
| | - Song Wu
- Hubei Province Engineering and Technology Research Center for Fluorinated Pharmaceuticals, School of Pharmaceutical Sciences, Wuhan University, China
| | - Xiang Hu
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, China
| | - Aixi Yu
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, China
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22
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Imaging following surgery for primary appendicular bone tumours. Skeletal Radiol 2021; 50:1527-1555. [PMID: 33481074 DOI: 10.1007/s00256-021-03712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
Primary bone tumours are uncommon, with sarcomas accounting for < 0.2% of all malignancies. The survival rate of primary bone sarcomas has significantly improved due to (neo)adjuvant therapy, while improved surgical techniques and development of new prostheses have shifted the surgical focus from amputation to limb preservation in the vast majority of patients. A wide variety of surgical options are available for the treatment of primary bone tumours which depend upon histological diagnosis, their appearance at the time of presentation and response to any (neo)adjuvant therapy as required. This review is intended to help radiologists familiarise themselves with the management of primary appendicular bone tumours and expected normal postoperative appearances for the various surgical techniques, and to recognise potential complications.
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Parikh RP, Sacks JM. Lower Extremity Reconstruction After Soft Tissue Sarcoma Resection. Clin Plast Surg 2021; 48:307-319. [PMID: 33674052 DOI: 10.1016/j.cps.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Surgical resection with wide margins and perioperative radiation therapy is the standard treatment of extremity soft tissue sarcomas. This combination often results in complex wounds and functional compromise. Reconstructive surgery is integral to limb salvage after sarcoma resection. Advances in adjuvant therapy and reconstructive surgical techniques have made functional limb salvage, instead of amputation, possible for most patients. This article reviews key concepts in the multidisciplinary care of patients with extremity soft tissue sarcomas and details reconstructive surgical techniques, including locoregional and free tissue transfer, free functional muscle transfer, and vascularized bone transfer, to optimize functional limb restoration after sarcoma resection.
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Affiliation(s)
- Rajiv P Parikh
- Plastic and Reconstructive Surgical Service, Center for Advanced Reconstruction, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Justin M Sacks
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Suite 1150 NWT, St Louis, MO 63110, USA.
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24
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Berner JE, Dearden A, Magdum AA, Crowley TP, Rankin K, Clarke MJ, Ragbir M. Safety of limb-salvaging surgery for sarcomas compromising major vessels: A 15-year single-centre outcomes study. J Plast Reconstr Aesthet Surg 2021; 74:2076-2084. [PMID: 33549508 DOI: 10.1016/j.bjps.2020.12.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Limb-threatening sarcomas invading major vessels present an oncological and reconstructive challenge. Curative resection involves either performing an amputation or an immediate reconstruction of the invaded vessels. We present our 15-year experience of these cases at the North of England Bone and Soft Tissue Tumour Service. MATERIALS AND METHODS A Strengthening the Reporting of Observational studies in Epidemiology (STROBE) compliant retrospective review of our prospective database was performed including patients who required major vessel reconstruction following sarcoma excision from 2003 until 2018. Patient demographic data along with tumour and histological subtypes, treatment modality, complications and outcomes were inquired. Autologous and prosthetic vessel reconstruction approaches were compared. RESULTS Nineteen patients were identified with the most common tumour locations being the thigh and groin areas. Five cases involved recurrent tumours. Clear resection margins were obtained in 15 cases. Autologous vein grafts were preferred over polytetrafluoroethylene (PTFE) prosthesis in 17 cases. A pedicled flap or free flap was required to achieve adequate soft tissue cover in six patients, while the rest underwent primary closure. Five patients lost the patency of the reconstructed vessels with one of these requiring an amputation. The estimated disease-specific survival at 5 years was 58%. DISCUSSION Limb-preservation surgery in the context of vessel compromise is not only safe, but also a functionally and psychosocially beneficial means of avoiding an amputation. We believe that careful pre-operative planning and discussion in a multidisciplinary setting is key for obtaining positive outcomes.
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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 upon Tyne, United Kingdom; Kellogg College, University of Oxford, Oxford, United Kingdom.
| | - Alexander Dearden
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ashish A Magdum
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Timothy P Crowley
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Kenneth Rankin
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Michael J Clarke
- Department of Vascular Surgery, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Maniram Ragbir
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Lazic I, Knebel C, Consalvo S, Rechl H, von Eisenhart-Rothe R, Lenze U. [Amputations around the knee]. DER ORTHOPADE 2020; 49:461-470. [PMID: 32266433 DOI: 10.1007/s00132-020-03906-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An amputation around, through or below the knee joint constitutes a "huge" change in a patient's life. In Orthopaedics, amputations are most frequently performed in cases with musculoskeletal tumours or failed total knee arthroplasty. A multidisciplinary team approach (surgeon, anaesthetist, pain specialists, orthotist, psychologist etc.) and patient-specific treatment regime from the outset as well as a meticulous surgical technique are of the outmost importance. Nowadays, prosthetic legs can be fitted for nearly any amputation level. The functional outcome of amputations below the knee is usually superior to amputations above or through the knee joint. Postoperative stump conditioning is paramount and the final prosthetic leg should not be fitted earlier than 4-6 months postoperatively. Problems with wound healing, muscle contractures and phantom limb pain represent common complications which might adversely affect patient outcomes.
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Affiliation(s)
- Igor Lazic
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Carolin Knebel
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Sarah Consalvo
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Hans Rechl
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Rüdiger von Eisenhart-Rothe
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Ulrich Lenze
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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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: 7] [Impact Index Per Article: 1.8] [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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Oncological and endoprosthetic outcomes of bone sarcoma patients: a nationwide cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:31-35. [PMID: 31324968 DOI: 10.1007/s00590-019-02503-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To retrospectively analyze the entire cohort of patients in the Republic of Slovenia diagnosed with bone sarcomas in the long bones or pelvis/sacrum/coccyx from January 1, 2009, to December 31, 2018, with an observational nationwide study, whereby all patients were evaluated by one single tumor board in the country. We evaluated surgical outcomes and tested whether survival of bone sarcoma patients depended on age, gender, histological diagnosis. MATERIALS AND METHODS Cancer Registry of the Republic of Slovenia was screened for all ICD-10 diagnoses from C40.0 to C40.9 and C41.4 in the designated time frame, and the patients were then clinically followed up until the end of the observation period on June 1, 2019. RESULTS The cohort of 160 patients was treated surgically in 141 cases, 29 patients required subsequent revision(s) and cumulative endoprosthetic infection rate was 12.5%. In the follow-up, 54 patients died and the 2 patients were missing. Cumulative proportion of survival at 5/10 years was 61%/54%, respectively. After adjustment for age, gender and diagnosis, higher age (odds ratio 1.06 for each additional year), osteosarcoma (odds ratio 4.07) and Ewing sarcoma (odds ratio 11.68) were the significant risk factors of shorter oncological survival. CONCLUSION This is the first Slovenian nationwide cohort study of bone sarcoma patients, unique in its circumscribed geographic area and evaluation/treatment at a single center by a single tumor board. Although comparable to other countries, results show a grim picture and the lack of improvement in bone sarcoma survival within the last 20 years.
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Cirstoiu C, Cretu B, Serban B, Panti Z, Nica M. Current review of surgical management options for extremity bone sarcomas. EFORT Open Rev 2019; 4:174-182. [PMID: 31191985 PMCID: PMC6540945 DOI: 10.1302/2058-5241.4.180048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Modern surgical management of extremity bone sarcomas is governed by limb-sparing surgery combined with adjuvant and neoadjuvant chemotherapy. All the resection and reconstruction techniques have to achieve oncologic excision margins, with survival rates and functional results superior to amputation. The main reconstruction techniques of bone defects resulted after resection are: modular endoprosthetic reconstruction; bone graft reconstruction; bone transport; resection arthrodesis; and rotationplasty. Oncologic resection and modular endoprosthetic reconstruction are the generally approved surgical options adopted for the majority of cases in major specialized bone sarcoma centres. Good basic principles, efficient multidisciplinary approach and sustained research in the field can provide a better future for the challenge posed by extremity bone sarcoma treatment.
Cite this article: EFORT Open Rev 2019;4:174-182. DOI: 10.1302/2058-5241.4.180048
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Affiliation(s)
- Catalin Cirstoiu
- Carol Davila University of Medicine and Pharmacy, Orthopedics and Traumatology Department, Bucharest, Romania.,University Emergency Hospital Bucharest, Romania
| | - Bogdan Cretu
- Carol Davila University of Medicine and Pharmacy, Orthopedics and Traumatology Department, Bucharest, Romania.,University Emergency Hospital Bucharest, Romania
| | - Bogdan Serban
- Carol Davila University of Medicine and Pharmacy, Orthopedics and Traumatology Department, Bucharest, Romania.,University Emergency Hospital Bucharest, Romania
| | - Zsombor Panti
- Carol Davila University of Medicine and Pharmacy, Orthopedics and Traumatology Department, Bucharest, Romania.,University Emergency Hospital Bucharest, Romania
| | - Mihai Nica
- Carol Davila University of Medicine and Pharmacy, Orthopedics and Traumatology Department, Bucharest, Romania.,University Emergency Hospital Bucharest, Romania
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29
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[Systematic planning of surgery for soft tissue sarcoma of the extremities]. Chirurg 2019; 90:441-446. [PMID: 30848291 DOI: 10.1007/s00104-019-0921-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Soft tissue sarcomas of the extremities are rarely malignant tumors. They are best treated by an experienced interdisciplinary sarcoma team. A preoperative biopsy and imaging are prerequisites for successful sarcoma treatment. Before surgery the multimodal treatment and the extent of resection and, if necessary, plastic reconstruction should be discussed in a multidisciplinary tumor board. The aim is always a complete R0 resection with optimal preservation of function. The preservation of critical structures (e. g. sciatic nerve) by a planned focal marginal resection along the critical structure can be performed by an experienced team in a multidisciplinary treatment setting.
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Mattei JC, Brouste V, Terrier P, Bonvalot S, Lecesne A, Stoeckle E, Italiano A, Ranchere-Vince D, Meeus P, Laé M, Rosset P, Rochwerger A, Coindre JM, Salas S. Distal extremities soft tissue sarcomas: Are they so different from other limb localizations? J Surg Oncol 2019; 119:479-488. [PMID: 30609044 DOI: 10.1002/jso.25359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 12/16/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Soft tissue sarcoma localization in distal extremities (DESTS) of the limbs (hand/fingers, and foot/toes) is unusual. The literature is scarce about their behavior and this study was designed to assess their epidemiological characteristics, outcomes, and prognosis compared to other limb localizations (OLSTS). METHODS From 1980 to 2010, adult DESTS and OLSTS in 22 centers were included. Demographics, tumor type, treatment modalities, and latest follow-up status were collected. Primary endpoints were overall survival and local/metastatic recurrence incidences. RESULTS Two hundred five DESTS and 3001 OLSTS were included. The patients were younger, with more female and smaller tumors in DESTS. There were more clear cell/epithelioid sarcomas, synovial sarcomas, and myxoid liposarcomas vs more dedifferentiated liposarcomas in OLSTS. DESTS tumors were less irradiated and more often amputated (24.3% vs 3.4%). The five-year survival rate was 78.2% compared to 68.6% in OLSTS and after multivariate analysis, STS localization did not impact survival or local/metastatic recurrence. CONCLUSION Though rare and smaller than other limb localizations, DESTS are to be considered as aggressive. Despite a higher amputation rate, the prognosis remains the same as in OLSTS. Limb sparing vs amputation should be carefully assessed in DESTS, especially if grade 3 or of a poor prognosis histological subtype.
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Affiliation(s)
- Jean-Camille Mattei
- Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Départment de Chirurgie Orthopédique des Prs. Curvale et Rochwerger, Marseille, France.,Faculté de Médecine de la Timone, Génétique Médicale et génomique fonctionnelle, UMR S910 Inserm, Université Aix-Marseille 2, Marseille, France
| | - Véronique Brouste
- Institut Bergonie, INSERM U 897, Département Biostatistique, ISPED, Université Victor Segalen Bordeaux 2, Case 11, Bordeaux, France
| | - Philippe Terrier
- Département de Biologie et de Pathologie Médicales, Institut de Cancérologie Gustave-Roussy, Villejuif, France
| | - Sylvie Bonvalot
- Institut Curie, Département de Chirurgie 8, PSL Research University, Paris, France
| | - Axel Lecesne
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Eberhard Stoeckle
- Department of Surgery, Institut Bergonié, Regional Cancer Centre, Bordeaux, France
| | - Antoine Italiano
- Departement d'oncologie Medicale, CLCC Institut Bergonie, Bordeaux, France
| | | | - Pierre Meeus
- Department of Surgery, Centre Leon Berard, University Lyon 1, Lyon, France
| | - Marick Laé
- Service de Pathologie, Institut Curie, Paris Sciences Lettres Research University, Département de Médecine Diagnostique et Théranostique, Paris, France.,Service de Pathologie, Centre Henri Becquerel, INSERM U1245, UNIROUEN, Normandie Université, rue d'Amiens, Rouen, France
| | - Philippe Rosset
- Département Chirurgie Orthopédique et Traumatologique 2, Hôpital Trousseau, Université François-Rabelais de Tours, CHU de Tours, Tours, France
| | - Alexandre Rochwerger
- Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Départment de Chirurgie Orthopédique des Prs. Curvale et Rochwerger, Marseille, France.,Faculté de Médecine de la Timone, Génétique Médicale et génomique fonctionnelle, UMR S910 Inserm, Université Aix-Marseille 2, Marseille, France
| | | | - Sébastien Salas
- Faculté de Médecine de la Timone, Génétique Médicale et génomique fonctionnelle, UMR S910 Inserm, Université Aix-Marseille 2, Marseille, France.,Department of Oncology, Assistance Publique Hôpitaux de Marseille Timone Hospital, Marseille, France
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Erstad DJ. ASO Author Reflections: Amputation for Extremity Sarcoma. Ann Surg Oncol 2018; 26:548. [PMID: 30556115 DOI: 10.1245/s10434-018-7069-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Derek J Erstad
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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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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