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Impact of close surgical margin on local recurrence and survival in osteosarcoma



Whether neoadjuvant chemotherapy safely allows close margins in osteosarcoma patients is still unknown. This study investigates the impact of close margins on local recurrence (LR) and overall survival (OS) for osteosarcoma patients treated with neoadjuvant chemotherapy.


We retrospectively reviewed 47 cases of conventional osteosarcoma who were treated at our institution. Patient and treatment factors such as age, gender, MSTS stage, tumour site, surgery type, pathological type, tumour size, surgical margin, tumour necrosis rate, chemotherapy regimens and cycles were recorded. A close margin was defined as tumour present less than 5 mm from the closest resection margin. The average followup was 87.6 months (range, 25–135 months).


Twenty-five patients were alive, 22 patients had died, and eight had LR. Twenty-eight patients had wide margins, seven had positive margins and 12 had close margins. Positive margins had a greater risk of LR (57.1%) than wide margins and close margins. There was no difference in LR (8.3% vs 10.7%) between close margins and wide margins. Margin status was not correlated with OS.


Compared with wide margins, close margins did not lead to increased local recurrence in our study group. Whether close margins, as defined in our study, are just as acceptable as wide margins in terms of patient outcomes for osteosarcoma patients with neoadjuvant chemotherapy needs to be further confirmed in the future.

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We thank Linda D. Pickron for assistance with collecting all the medical charts for this research.

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Correspondence to Richard D. Lackman.

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Xin Li received funding in the form of a visiting scholarship from the China Scholarship Council; Vincent M. Moretti and Adedayo O. Ashana received funding in the form of a research fellowship from Stryker Orthopaedics, Mahwah, NJ. One of the authors (RDL) is a consultant for Stryker Orthopaedics, Mahwah, NJ.

This work was performed in the Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigators were conducted in conformity with ethical principles for research. This study was approved by the Institutional Review Board.

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Li, X., Moretti, V.M., Ashana, A.O. et al. Impact of close surgical margin on local recurrence and survival in osteosarcoma. International Orthopaedics (SICOT) 36, 131–137 (2012).

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  • Overall Survival
  • Local Recurrence
  • Osteosarcoma
  • Preoperative Chemotherapy
  • Positive Margin