Abstract
Background
Standardizing limb salvage surgery for malignant bone tumors should result in improved limb function after tumor excision and reconstruction. Recently, we developed and clinically applied a method of biological reconstruction using tumor-bearing autografts treated with liquid nitrogen. We report this newly modified technique using pedicle frozen autografts to save the continuity of anatomical structures.
Methods
We treated 33 malignant bone tumor patients. Diagnoses of the tumors were 17 osteosarcomas, 11 metastatic tumors, 2 Ewing’s sarcomas, 2 chondrosarcomas, and 1 undifferentiated pleomorphic sarcoma. The sites of the tumors were 23 femurs, 5 tibias, 4 humeri, and 1 calcaneus. Operative procedures consisted of exposing the tumor, performing one-site osteotomy or joint dislocation, rotating and freezing the tumor lesion in liquid nitrogen for 20 min, and reconstruction using intramedullary nailing, plates, or composite arthroplasty.
Results
Postoperative function was excellent in 25 patients (75.7%), good in 5 patients (15.1%), and fair in 3 patients (9.0%). At the final follow-up, 8 patients had died at a mean of 17 months postoperatively, and 18 patients remained disease-free for a mean follow-up period of 30 months (range 7–69 months). Seven patients were alive but with disease. Complications were encountered in 12 patients, including 4 deep infections, 3 fractures, 3 local recurrences from surrounding soft tissue, 2 nonunions, and 1 collapse. All were managed successfully.
Conclusions
The pedicle frozen autograft, which was newly developed to solve drawbacks of previously reported free frozen autografts, achieved success for reconstruction of malignant bone tumors. This is a new, simple, effective surgical technique for biological reconstruction that is still investigated but has potential for development.
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References
Araki N, Myoui A, Kuratsu S, Hashimoto N, Inoue T, Kudawara I, et al. Intraoperative extracorporeal autogenous irradiated bone grafts in tumor surgery. Clin Orthop 1999;368:196–206.
Asada N, Tsuchiya H, Kitaoka K, Mori Y, Tomita K. Massive autoclaved allografts and autografts for limb salvage surgery: a 1–8 year follow-up of 23 patients. Acta Orthop Scand 1997;68:392–395.
Manabe J, Ahmed AR, Kawaguchi N, Matsumoto S, Kuroda H. Pasteurized autologous bone graft in surgery for bone and soft tissue sarcoma. Clin Orthop 2004 419:258–266.
Sakayama K, Kidani T, Fujibuchi T, Kamogawa J, Yamamoto H, Shibata T. Reconstruction surgery for patients with musculoskeletal tumor, using a pasteurized autogenous bone graft. Int J Clin Oncol 2004;9:167–173.
Urist MR, Dawson E. Intertransverse process fusion with the aid of chemosterilized autolyzed antigen-extracted allogeneic (AAA) bone. Clin Orthop 1981;154:97–113.
Tsuchiya H, Wan SL, Sakayama K, Yamamoto N, Nishida H, Tomita K. Reconstruction using an autograft containing tumor treated by liquid nitrogen. J Bone Joint Surg Br 2005;87:218–225.
Yamamoto N, Tsuchiya H, Tomita K. Effects of liquid nitrogen treatment on the proliferation of osteosarcomas and biomechanical properties of normal bone. J Ortho Sci 2003;8:374–380.
Tsuchiya H, Tomita K, Mori Y, Asada N, Yamamoto N. Marginal excision for osteosarcoma with caffeine assisted chemotherapy. Clin Orthop 1999;358:27–35.
Enneking WF. A system for functional evaluation of surgical management of musculoskeletal tumors. In: Enneking WF, editor. Limb salvage in musculoskeletal oncology. New York: Churchill-Livingstone; 1987. p. 5–16.
Cooper IS. Cryosurgery surgery of the basal ganglia. JAMA 1962;181:600–604.
Shafir M, Shapiro R, Sung M, Warner R, Sicular A, Klipfel A. Cryoablation of unresectable malignant liver tumors. Am J Surg 1996;171:27–31.
Uchida M, Imaide Y, Sugimoto K, Uehara H, Watanabe H. Percutaneous cryosurgery for renal tumors. Br J Urol 1995;75:132–137.
Popescu V, Spirescu E. Bone resection, extra-corporeal cryotherapy and immediate reimplantation in the treatment of mandibular tumors. J Maxillofac Surg 1980;8:8–16.
Leipzig B, Cummings CW. The current status of mandibular reconstruction using autogenous frozen mandibular grafts. Head Neck Surg 1984;6:992–997.
Marcove RC, Miller TR. The treatment of primary and metastatic localized bone tumors by cryosurgery. Surg Clin North Am 1969;49:421–430.
Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y. Cryosurgery in the treatment of giant cell tumor: a long-term follow-up study. Clin Orthop 1999;359:176–188.
Veth R, Schreuder B, van Beem H, Pruszczynski M, de Rooy J. Cryosurgery in aggressive, benign, and low-grade malignant bone tumors. Lancet Oncol 2005;6:25–34.
Nishida H, Tsuchiya H, Tomita K. Re-implantation of destructive tumor tissue treated by liquid nitrogen cryotreatment induces anti-tumor activity against murine osteosarcoma. J Bone Joint Surg Br 2008;90:1249–1255.
Enneking WF, Campanacci DA. Retrieved human allografts: a clinicopathological study. J Bone Joint Surg Am 2001;83:971–986.
Sorger JI, Hornicek FJ, Zavatta M, Menzner JP, Gebhardt MC, Tomford WW, et al. Allograft fractures revisited. Clin Orthop 2001;382:66–74.
Thompson RC Jr, Garg A, Clohisy DR, Cheng EY. Fractures in large-segment allografts. Clin Orthop 2000;370:227–235.
Hornicek FJ Jr, Mnaymneh W, Lackman RD, Exner GU, Malinin TI. Limb salvage with osteoarticular allografts after resection of proximal tibia bone tumors. Clin Orthop 1998;352:179–186.
Vander Griend RA. The effect of internal fixation on the healing of large allografts. J Bone Joint Surg Am 1994;76:657–663.
Tanzawa Y, Tsuchiya H, Shirai T, Hayashi K, Yo Z, Tomita K. Histological examination of frozen autograft treated by liquid nitrogen removed after implantation. J Orthop Sci 2009;14:761–768.
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Tsuchiya, H., Nishida, H., Srisawat, P. et al. Pedicle frozen autograft reconstruction in malignant bone tumors. J Orthop Sci 15, 340–349 (2010). https://doi.org/10.1007/s00776-010-1458-0
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DOI: https://doi.org/10.1007/s00776-010-1458-0