Megaprosthesis for Metastasis of the Lower Limb
In the past, the surgical approach to bone metastasis had the sole purpose to solve a biomechanical problem because the patient would die for systemic disease progression. Intramedullary nailing was the mainstay of the treatment, and its aim was allowing the patient to stand, with local tumor control achieved by radiotherapy [1, 2]. The improvement of medical therapy, radiotherapy and new diagnostic techniques have led to an increment of global life expectancy in bone metastatic patients, so complications related to the first surgery, often requiring further surgeries, are more common (Fig.1) [3, 5].Today, the surgeon has to take the possibility of a long survival into account, moreover if the patient has just one bone metastatic disease; this means performing more resections with wide margins and prosthetic reconstruction than before .Resection has to be considered after taking account of several factors which have to be evaluated from a multidisciplinary point of view and considering life expectancy: the oncologist, the orthopedic surgeon, the pathologist, the radiotherapist and the anesthesiologist are the main protagonists. The final decision has to be taken by the patient, once correctly informed about advantages and disadvantages of the possible procedures .