Journal of Orthopaedic Science

, Volume 2, Issue 4, pp 271–276 | Cite as

Reconstructive limb-sparing surgery following resection of aggressive tumors of the extremities and pelvis

  • Norman S. Schachar
Instructional Lecture

Abstract

Current strategies for limb-salvage surgery for bone and soft tissue tumors include improved staging and surgical techniques and neoadjuvant and adjuvant therapy. Conservative surgery for soft tissue tumors, using adjuvant therapy, is now established as a standard approach. A population-based, prospective cohort trial of neoadjuvant treatment in conservative surgery for soft tissue sarcomas has recetly been carried out. Data available on 40 patients followed for 24–110 months found that local control for conservative surgery for soft tissue sarcomas overall was 97.5%. Survival at 10 years was approximately 40% and did not seem to be changed despite a drop in local recurrence. These results have been applied to a cohort of patients with bone sarcoma, with equally promising results. Limb-sparing resection with osteoarticular allograft reconstruction in the proximal tibia, the distal femur, and the proximal humerus have yielded very good to excellent results. Osteoarticular allografts do give rise to a number of complications. Alternatives to allografts involve the use of implant arthroplasties, either custom-designed or modular in design, as well as intercalary allografts. There is increasing interest in using outcome data collection methodology to assess the quality of life of patients who have undergone reconstruction with limb-salage surgery following resection of aggressive lesions of the extremities and pelvis.

Key words

limb salvage neoadjuvant therapy soft tissue sarcomas implant allograft 

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References

  1. 1.
    Aboulafia AJ, Malawer MM. Surgical management of pelvic and extremity osteosarcoma. Cancer 1993;71(Suppl 10):3358–66.PubMedCrossRefGoogle Scholar
  2. 2.
    Bacci G, Picci P, Ferrari S, et al. Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer 1993;72:3227–38.PubMedCrossRefGoogle Scholar
  3. 3.
    Cakir S, Dincbas FO, Uzel O, et al. Multivariate analysis of prognostic factors in 75 patients with soft tissue sarcoma. Radiother Oncol 1995;37:10–16.PubMedCrossRefGoogle Scholar
  4. 4.
    Clohisy DR, Mankin HJ. Osteoarticular allografts for reconstruction after resection of a musculoskeletal tumor in the proximal end of the tibia. J Bone Joint Surg Am 1994;76-A,4:549–54.Google Scholar
  5. 5.
    Damron TA, Pritchard DJ. Current combined treatment of highgrade osteosarcomas. Oncology 1995;9:327–43.PubMedGoogle Scholar
  6. 6.
    Drake DB. Reconstruction for limb-sparing procedures in soft-tissue sarcomas of the extremities. Clin Plast Surg 1995;22:123–8.PubMedGoogle Scholar
  7. 7.
    Eilber FR, Guiliano AE, Huth J, et al. Limb salvage for highgrade soft tissue sarcomas of the extremity: Experience at the University of California, Los Angeles. Cancer Treat Sympos 1985;3:49–57.Google Scholar
  8. 8.
    Goorin AM, Perez-Atayde A, Gebhardt M, et al. Weekly high-dose methotrexate and doxorubicin for osteosarcoma: The Dana-Farber Cancer Institute/the Children's Hospital Study III. J Clin Oncol 1987;5:1178–84.PubMedGoogle Scholar
  9. 9.
    Herbert SH, Corn BW, Solin LJ, et al. Limb-preserving treatment for soft tissue sarcomas of the extremities. The significance of surgical margins. Cancer 1993;72:1230–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Karakousis CP, Proimakis C, Walsh DL. Primary soft tissue sarcoma of the extremities in adults. Br J Surg 1995;82:1208–12.PubMedGoogle Scholar
  11. 11.
    Keus RB, Rutgers EJ, Ho GH. et al. Limb-sparing therapy of extremity soft tissue sarcomas: Treatment outcome and long-term functional results. Eur J Cancer 1994;30A:1459–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Mankin HJ, Gebhardt MC, Jenniongs C, et al. Long-term results of allograft replacement in the management of bone tumors. Clin Orthop 1996;324:86–97.PubMedCrossRefGoogle Scholar
  13. 13.
    McDonald DJ. Limb-salvage surgery for treatment of sarcomas of the extremities. AJR Am J Roentgenol 1994;163:509–13.PubMedGoogle Scholar
  14. 14.
    Moseley HS. An evaluation of two methods of limb salvage in extremity soft-tissue sarcomas. Arch Surg 1992;127:1169–73.PubMedGoogle Scholar
  15. 15.
    Nichter LS, Menendez LR. Reconstructive considerations for limb salvage surgery. Orthop Clin North Am 1993;24:511–21.PubMedGoogle Scholar
  16. 16.
    Postma A, Kingma A, De Ruiter JH, et al. Quality of life in bone tumor patients comparing limb salvage and amputation of the lower extremity. J Surg Oncol 1992;51:47–51.PubMedGoogle Scholar
  17. 17.
    Sauter ER, Hoffman JP, Eisenberg BL. Diagnosis and surgical management of locally recurrent soft-tissue sarcomas of the extremity. Semin Oncol 1993;20:451–5.PubMedGoogle Scholar
  18. 18.
    Simon MA, Aschliman MA, Thomas N, et al. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am 1986;68-A, 9:1331–7.Google Scholar
  19. 19.
    Spiro IJ, Rosenberg AE, Springfield D, et al. Combined surgery and radiation therapy for limb preservation in soft tissue sarcoma of the extremity: The Massachusetts General Hospital experience. Cancer Invest 1995;13:86–95.PubMedGoogle Scholar
  20. 20.
    Subhadrabandhu T, Pochanugool L, Nontasut S, et al. Limb salvage for extremity sarcoma in Ramathibodi Hospital. J Med Assoc Thailand 1992;75 Suppl(1):112–8.Google Scholar
  21. 21.
    Tanabe KK, Pollock RE, Ellis LM, et al. Influence of surgical margins on outcome in patients with preoperatively irradiated extremity soft tissue sarcomas. Cancer 1994;73:1652–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Temple WJ, Alexander F, Arthur K, et al. Limb-salvage surgery for widely infiltrating bony sarcomas. Can J Surg 1994;37:479–82.PubMedGoogle Scholar
  23. 23.
    Tomford WW, Bloem RM, Mankin HJ. Osteoarticular allografts. Acta Orthop Belg 1991;57(Suppl 2):98–102.PubMedGoogle Scholar
  24. 24.
    Watson DI, Coventry BJ, Langlois S, et al. Soft-tissue sarcoma of the extremity. Experience with limb-sparing surgery. Med J Aust 1994;160:412–416.PubMedGoogle Scholar
  25. 25.
    Willett CG, Schiller AL, Suit HD, et al. The histologic response of soft tissue sarcoma to radiation therapy. Cancer 1987;60:1500–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Williard WC, Hajdu SI, Casper ES, et al. Comparison of amputation with limb-sparing operations for adult soft tissue sarcoma of the extremity. Ann Surg 1992;215:269–75.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Orthopaedic Association 1997

Authors and Affiliations

  • Norman S. Schachar
    • 1
  1. 1.Department of Surgery, Faculty of MedicineThe University of Calgary, Heritage Medical Research BuildingCalgaryCanada

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