Short Term Complications and Functional Results of Sarcoma Limb Salvage Surgeries | ||
| The Archives of Bone and Joint Surgery | ||
| مقاله 9، دوره 7، شماره 2، خرداد و تیر 2019، صفحه 161-167 اصل مقاله (1.21 M) | ||
| نوع مقاله: RESEARCH PAPER | ||
| شناسه دیجیتال (DOI): 10.22038/abjs.2018.31453.1816 | ||
| نویسندگان | ||
| Mohammad Ghareh Daghi1؛ Mohammad Hassani* 2؛ Ali Parsa1؛ Farzad Omidi-Kashani1؛ Lida Jarahi3؛ rahim hosseini4 | ||
| 1Orthopedic Research Center, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran | ||
| 2Department of Orthopedic Surgery, Orthopedic Research Centre, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran | ||
| 3Mashhad University of Medical Sciences (MUMS), Mashhad, Iran | ||
| 4Department of Orthopedic Surgery, Imamreza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran | ||
| چکیده | ||
| Background: Limb salvaging surgeries are current surgical treatment of extremity bone sarcomas. Resected bone replacement consists of two main methods; tumor prosthesis versus structural allograft. Biological reconstruction with an allograft is an economic cheap method in young sarcoma patients, however, the surgeons are more convinced with tumor prosthesis replacement. Methods: We evaluated the short-term complications and functional results of 40 patients with aggressive extremity tumors in a retrospective cohort study. The mean age of cases was 25 and we followed them for 24 months. 17 patients underwent tumor prosthesis replacement after wide resection of limb sarcomas. 16 cases had structural allograft reconstruction and 7 patients treated with amputation. We matched confounders including age, sex, blood cell count and chemotherapy treatment in the study groups. Results: We found 15 major complications (45.5%) in limb salvage surgeries composing infection, allograft nonunion, allograft fracture, prosthesis fracture, prosthesis loosening and device failure that needed another surgery to be resolved. We had 10 major complications in allograft group (62%) and 5 in tumor prosthesis group (29.4%). Although the rate of complications was higher in allograft group, it didn’t statistically indicate strong correlation (Fisher’s exact: 0.084). Mean Musculo-Skeletal tumor rating Scale (MSTS) score was 25.8(73.7%) and 22.3(63.7%) in allograft group and prosthesis cases respectively. MSTS score had a normal distribution in the different groups with no significant difference between them. Conclusion: Although complications were higher in the allograft group, allograft could be offered to bone sarcoma patients, whom are predicted to have short life expectancy. Level of evidence: III | ||
| کلیدواژهها | ||
| Allograft؛ Limb salvage؛ Sarcoma؛ Tumor prosthesis | ||
| مراجع | ||
|
1. Fletcher CD. World Health Organization classification of tumours pathology and genetics of tumours of soft tissue and bone. Lyon: IARC Press; 2002. 2. Eilber FR, Mirra JJ, Grant TT, Weisenberger T, Morton DL. Is amputation necessary for sarcomas? A sevenyear experience with limb salvage. Ann Surg. 1980; 192(4):431-8. 3. DiCaprio MR, Friedlaender GE. Malignant bone tumors: limb sparing versus amputation. J Am Acad Orthop Surg. 2003; 11(1):25-37. 4. Bacci G, Ferrari S, Longhi A, Donati D, Manfrini M, Giacomini S, et al. Nonmetastatic osteosarcoma of the extremity with pathologic fracture at presentation, local and systemic control by amputation or limb salvage after preoperative chemotherapy. Acta Orthop Scand. 2003; 74(4):449-54. 5. Han G, Bi WZ, Xu M, Jia JP, Wang Y. Amputation versus limb-salvage surgery in patients with osteosarcoma: a meta-analysis. World J Surg. 2016; 40(8):2016-27. 6. Albergo JI, Gaston CL, Aponte-Tinao LA, Ayerza MA, Muscolo DL, Grimer RJ, et al. Proximal tibia reconstruction after bone tumor resection: are survivorship and outcomes of endoprosthetic replacement and osteoarticular allograft similar? Clin Orthop Relat Res. 2017; 475(3):676-82. 7. Ayerza A, Farfalli G, Aponte-Tinao L, Muscolo D. Does increased rate of limb-sparing surgery affect survival in osteosarcoma? Clin Orthop Relat Res. 2010; 468(11):2854-9. 8. Bacci G, Forni C, Longhi A, Ferrari S, Mercuri M, Picci P, et al. local recurrence and local control of nonmetastatic osteosarcoma of the extremities: a 27-year experience in a single institution. J Surg Oncol. 2007; 96(2):118-23. 9. Eiser C, Darlington AS, Stride CB, Grimer R. Quality of life implications as a consequence of surgery: limb salvage, primary and secondary amputation. Sarcoma. 2001; 5(4):189-95. 10. Gundle KR, Cizik AM, Jones RL, Davidson DJ. Quality of life measures in soft tissue sarcoma. Expert Rev Anticancer Ther. 2015; 15(1):95-100. 11. Mavrogenis AF, Abati CN, Romagnoli C, Ruggieri P. Similar survival but better function for patients after limb salvage versus amputation for distal tibia osteosarcoma. Clin Orthop Relat Res. 2012; 470(6):1735-48. 12. Mei J, Zhu XZ, Wang ZY, Cai XS. Functional outcomes and quality of life in patients with osteosarcoma treated with amputation versus limb-salvage surgery: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2014; 134(11):1507-16. 13. Abed YY, Beltrami G, Campanacci DA, Innocenti M, Scoccianti G, Capanna R. Biological reconstruction after resection of bone tumors around the knee: long-term follow-up. J Bone Joint Surg Br. 2009; 91(10):1366-72. 14. Campanacci L, Alì N, Casanova JM, Kreshak J, Manfrini M. Resurfaced allograft-prosthetic composite for proximal tibial reconstruction in children: intermediate-term results of an original technique. J Bone Joint Surg Am. 2015; 97(3):241-50. 15. Levin AS, Arkader A, Morris CD. Reconstruction following tumor resections in skeletally immature patients. J Am Acad Orthop Surg. 2017; 25(3):204-13. 16. Wilson RJ, Sulieman LM, VanHouten JP, Halpern JL, Schwartz HS, Holt GE, et al. Cost-utility of osteoarticular allograft versus endoprosthetic reconstruction for primary bone sarcoma of the knee: a Markova analysis. J Surg Oncol. 2017; 115(3):257-65. 17. Gharedaghi M, Peivandi MT, Mazloomi M, Shoorin HR, Hasani M, Seyf P, et al. Evaluation of clinical results and complications of structural allograft reconstruction after bone tumor surgery. Arch Bone Jt Surg. 2016; 4(3):236-42. | ||
|
آمار تعداد مشاهده مقاله: 448 تعداد دریافت فایل اصل مقاله: 288 |
||