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Erschienen in: Journal of Cancer Research and Clinical Oncology 10/2008

01.10.2008 | Original Paper

Usefulness of limb salvage surgery for bone and soft tissue sarcomas of the distal lower leg

verfasst von: Rui Niimi, Akihiko Matsumine, Katsuyuki Kusuzaki, Shigeyuki Kuratsu, Nobuhito Araki, Yasuaki Aoki, Takafumi Ueda, Ikuo Kudawara, Akira Myoui, Makoto Ieguchi, Nobuyuki Hashimoto, Hideki Yoshikawa, Atsumasa Uchida

Erschienen in: Journal of Cancer Research and Clinical Oncology | Ausgabe 10/2008

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Abstract

Purpose

The usefulness of limb salvage surgery for distal lower leg sarcoma remains controversial. We analyzed the long-term prognosis, limb function, and complications after limb salvage treatment of patients with distal lower leg sarcoma.

Methods

Ten patients treated with limb salvage surgery for primary distal lower leg sarcoma were retrospectively reviewed. The median follow-up period after the first operation was 9.0 years. We performed three types of reconstructive techniques for the skeletal defect after a wide resection, including (1) arthrodesis with a combination of autograft and intraoperative autoclaved tumor bone graft in two patients, or allograft in one patient, (2) ankle joint preserving surgery using intraoperative extracorporeal irradiated tumor bone graft in five patients, and (3) prosthesis in two patients.

Results

The overall survival rate was 80%. The 5-year disease-free survival was 80%. The rate of limb preservation at the final follow-up was 90%. The mean functional score according to the scoring system of the Musculoskeletal Tumor Society was 88% at the final follow-up. Postoperative complications occurred in seven patients. Skin trouble occurred in three patients, infectious non-union in one patient, fracture in three patients, and loosening of prosthesis in one patient.

Conclusions

Despite the high rate of complications, patients treated with limb salvage surgery for the distal lower leg sarcoma revealed excellent final functional results without impairing the oncologic results. Limb salvage surgery is therefore considered to be an effective treatment option for distal lower leg sarcoma when adequate informed consent can be obtained from the patient.
Literatur
Zurück zum Zitat Abudu A, Grimer RJ, Tillman RM, Carter SR (1999) Endoprosthetic replacement of the distal tibia and ankle joint for aggressive bone tumours. Int Orthop 23:291–294PubMedCrossRef Abudu A, Grimer RJ, Tillman RM, Carter SR (1999) Endoprosthetic replacement of the distal tibia and ankle joint for aggressive bone tumours. Int Orthop 23:291–294PubMedCrossRef
Zurück zum Zitat Araki N, Myoui A, Kuratsu S, Hashimoto N, Inoue T, Kudawara I, Ueda T, Yoshikawa H, Masaki N, Uchida A (1999) Intraoperative extracorporeal autogenous irradiated bone grafts in tumor surgery. Clin Orthop Relat Res 368:196–206PubMedCrossRef Araki N, Myoui A, Kuratsu S, Hashimoto N, Inoue T, Kudawara I, Ueda T, Yoshikawa H, Masaki N, Uchida A (1999) Intraoperative extracorporeal autogenous irradiated bone grafts in tumor surgery. Clin Orthop Relat Res 368:196–206PubMedCrossRef
Zurück zum Zitat Bishop AT, Wood MB, Sheetz KK (1995) Arthrodesis of the ankle with a free vascularized autogenous bone graft. J Bone Joint Surg 77A:1867–1875 Bishop AT, Wood MB, Sheetz KK (1995) Arthrodesis of the ankle with a free vascularized autogenous bone graft. J Bone Joint Surg 77A:1867–1875
Zurück zum Zitat Böhm P, Springfeld R, Springer H (1998) Re-implantation of autoclaved bone segments in musculoskeletal tumor surgery. Clinical experience in 9 patients followed for 1.1–8.4 years and review of the literature. Arch Orthop Trauma Surg 118:57–65PubMedCrossRef Böhm P, Springfeld R, Springer H (1998) Re-implantation of autoclaved bone segments in musculoskeletal tumor surgery. Clinical experience in 9 patients followed for 1.1–8.4 years and review of the literature. Arch Orthop Trauma Surg 118:57–65PubMedCrossRef
Zurück zum Zitat Casadei R, Ruggieri P, Giuseppe T, Biagini R, Mercuri M (1994) Ankle resection arthrodesis in patients with bone tumors. Foot Ankle Int 15:242–249PubMed Casadei R, Ruggieri P, Giuseppe T, Biagini R, Mercuri M (1994) Ankle resection arthrodesis in patients with bone tumors. Foot Ankle Int 15:242–249PubMed
Zurück zum Zitat Chen WM, Chen TH, Huang CK, Chiang HCC, Lo WH (2002) Treatment of malignant bone tumours by extracorporeally irradiated autograft-prosthetic composite arthroplasty. J Bone Joint Surg 84B:1156–1161CrossRef Chen WM, Chen TH, Huang CK, Chiang HCC, Lo WH (2002) Treatment of malignant bone tumours by extracorporeally irradiated autograft-prosthetic composite arthroplasty. J Bone Joint Surg 84B:1156–1161CrossRef
Zurück zum Zitat Doets HC, Brand R, Nelissen RG (2006) Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. J Bone Joint Surg 88A:1272–1284CrossRef Doets HC, Brand R, Nelissen RG (2006) Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. J Bone Joint Surg 88A:1272–1284CrossRef
Zurück zum Zitat Enneking WF (1986) A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 204:9–24PubMed Enneking WF (1986) A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 204:9–24PubMed
Zurück zum Zitat Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246PubMed Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246PubMed
Zurück zum Zitat Khattak MJ, Umer M, Haroon-ur-Rasheed, Umar M (2006) Autoclaved tumor bone for reconstruction. Clin Orthop Relat Res 447:138–144PubMedCrossRef Khattak MJ, Umer M, Haroon-ur-Rasheed, Umar M (2006) Autoclaved tumor bone for reconstruction. Clin Orthop Relat Res 447:138–144PubMedCrossRef
Zurück zum Zitat Lee SH, Kim HS, Park YB, Rhie TY, Lee HK (1999) Prosthetic reconstruction for tumours of the distal tibia and fibula. J Bone Joint Surg 81B:803–807CrossRef Lee SH, Kim HS, Park YB, Rhie TY, Lee HK (1999) Prosthetic reconstruction for tumours of the distal tibia and fibula. J Bone Joint Surg 81B:803–807CrossRef
Zurück zum Zitat Papagelopoulos PJ, Savvidou OD, Mavrogenis AF, Galanis EC, Shaughnessy WJ, Unni KK, Sim FH (2005) Lateral malleolus en bloc resection and ankle reconstruction for malignant tumors. Clin Orthop Relat Res 437:209–218PubMedCrossRef Papagelopoulos PJ, Savvidou OD, Mavrogenis AF, Galanis EC, Shaughnessy WJ, Unni KK, Sim FH (2005) Lateral malleolus en bloc resection and ankle reconstruction for malignant tumors. Clin Orthop Relat Res 437:209–218PubMedCrossRef
Zurück zum Zitat Renard AJ, Veth RP, Schreuder HWB, Loon CJV, Koops HS, Horn JRV (2000) Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol 73:198–205PubMedCrossRef Renard AJ, Veth RP, Schreuder HWB, Loon CJV, Koops HS, Horn JRV (2000) Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol 73:198–205PubMedCrossRef
Zurück zum Zitat Shalaby S, Shalaby H, Bassiony A (2006) Limb salvage for osteosarcoma of the distal tibia with resection arthrodesis, autogenous fibular graft and Ilizarov external fixator. J Bone Joint Surg 88B:1642–1646 Shalaby S, Shalaby H, Bassiony A (2006) Limb salvage for osteosarcoma of the distal tibia with resection arthrodesis, autogenous fibular graft and Ilizarov external fixator. J Bone Joint Surg 88B:1642–1646
Zurück zum Zitat Veth R, Hoesel R, Pruszczynski M, Hoogenhout J, Schreuder B, Wobbes T (2003) Limb salvage in musculoskeletal oncology. Lancet Oncol 4:343–350PubMedCrossRef Veth R, Hoesel R, Pruszczynski M, Hoogenhout J, Schreuder B, Wobbes T (2003) Limb salvage in musculoskeletal oncology. Lancet Oncol 4:343–350PubMedCrossRef
Zurück zum Zitat Zaretski A, Amir A, Meller I, Leshem D, Kollender Y, Barnea Y, Bickels J, Shpitzer T, Ad-El D, Gur E (2004) Free fibula long bone reconstruction in orthopedic oncology: a surgical algorithm for reconstructive options. Plast Reconstr Surg 113:1989–2000PubMed Zaretski A, Amir A, Meller I, Leshem D, Kollender Y, Barnea Y, Bickels J, Shpitzer T, Ad-El D, Gur E (2004) Free fibula long bone reconstruction in orthopedic oncology: a surgical algorithm for reconstructive options. Plast Reconstr Surg 113:1989–2000PubMed
Metadaten
Titel
Usefulness of limb salvage surgery for bone and soft tissue sarcomas of the distal lower leg
verfasst von
Rui Niimi
Akihiko Matsumine
Katsuyuki Kusuzaki
Shigeyuki Kuratsu
Nobuhito Araki
Yasuaki Aoki
Takafumi Ueda
Ikuo Kudawara
Akira Myoui
Makoto Ieguchi
Nobuyuki Hashimoto
Hideki Yoshikawa
Atsumasa Uchida
Publikationsdatum
01.10.2008
Verlag
Springer-Verlag
Erschienen in
Journal of Cancer Research and Clinical Oncology / Ausgabe 10/2008
Print ISSN: 0171-5216
Elektronische ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-008-0386-2

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