Rotationplasty is one treatment option for femoral bone sarcomas in skeletally immature patients. This procedure enables patients to avoid phantom pain, limb length discrepancy, or loosening of an endoprosthesis, and good functional outcome has been reported. However, rotationplasty is only rarely indicated and the surgical complications or risk factors for failure of the procedure that might influence choices of treatment or patient counseling have not been well described. We reviewed 25 patients who underwent rotationplasty focusing on risk factors for failure and postoperative complications. Three of 25 patients had vascular compromise resulting in amputation. All three had vascular anastomosis and were resistant to chemotherapy with less than 95% of tumor necrosis. Two of the three patients who underwent amputation had a pathologic fracture before surgery. Late complications included one patient with a tibial fracture, two with wound complications treated with skin grafts, one with nonunion,
Background Lymph node metastases in patients with soft tissue sarcomas are rare and these metastases are frequently associated with certain histologic subtypes. The survival is believed to be poor if lymph node metastases occur and the potential benefit of lymphadenectomy is unclear. Questions/purposes We determined whether lymph node metastases affect overall survival with regard to the status of lymphadenectomy, histologic subtypes, isolated or systemic metastasis, and the timing of presentation of lymph node metastases.Methods We retrospectively reviewed all 871 patients diagnosed with soft tissue sarcomas between 1983 and 2008 to determine whether they had lymph node metastases at diagnosis or subsequently and whether they had lymphadenectomy for treatment. Overall survival was assessed and the effect of prognostic variables was examined by a log rank test. Results Forty-nine of the 871 patients (6%) had lymph node metastases. The estimated 5-year survival rate for the group of 49 patients with lymph node metastases was 27%. Those who had lymphadenectomy had better survival at 1.5 years although there was no difference between those who did not undergo lymphadenectomy at 5 years. Patients with nonrhabdomyosarcoma had better overall survival than patients with rhabdomyosarcoma. Timing of development of lymph node involvement and whether lymph node metastases were an isolated site did not affect the overall survival. Conclusions Overall survival of patients with lymph node metastases was related to histologic subtypes and patients with nonrhabdomyosarcoma had better survival than those with rhabdomyosarcoma.
Background Pediatric soft tissue sarcomas are rare and differ from those in adults regarding the spectrum of diagnoses and treatment. Sarcomas in extremities may have different prognoses from those located elsewhere. Questions/purposes We sought risk factors predicting local recurrence, metastasis, and overall survival and asked whether radiation and chemotherapy influenced local recurrence, metastasis, and overall survival. Methods We retrospectively reviewed all 98 patients aged 18 years or younger diagnosed with soft tissue sarcomas in extremities from 1990 to 2008. Age, tumor size, depth, location, bone or neurovascular involvement, histologic subtypes, unplanned excision, surgical margins, metastasis at diagnosis, and adjuvant treatments were reviewed for each patient. We determined the effect of each prognostic variable on local recurrence, metastasis, and overall survival. Results Ninety-four patients underwent surgical excision and seven patients had local recurrence at a median time of 18.6 months. Radiation therapy reduced the rate of local recurrence. Fourteen patients had metastasis at diagnosis and seven patients later developed metastasis. The median time to metastasis was 20.9 months. Six patients died and the median time to death was 28.0 months. Metastasis at diagnosis was a predictive factor for death. Conclusions When limited to extremities, radiation therapy reduced the rate of local recurrence in pediatric soft tissue sarcomas. Metastases at diagnosis predict death. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at
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