Complex surgery for locally advanced bone and soft tissue sarcomas of the shoulder girdle

Abstract

Surgical management of primary musculoskeletal tumors of the shoulder girdle is cognitively and technically demanding. Over the last decades, advances in the medical treatments, imaging and surgical techniques have fostered limb salvage surgery and reduced the need for amputation. Despite well-accepted general principles, an individualized approach is often necessary to accommodate tumor extension, anatomical challenges and patient characteristics. A combination of techniques is often required to achieve optimal oncologic and durable functional outcome. Goal of this article is to review approach and management of patients with locally advanced sarcomas of the shoulder girdle requiring major tumor surgery, to illustrate principles of surgical strategy, outcome and complications, and to provide useful guidelines for the treating physicians.

A reconstructive algorithm of oncologic defects of the upper trunk and shoulder girdle: Factors predicting complexity and outcomes

“…In this patient population, the 1, 2, and 5‐year survival rates were ∼85%, 73%, and 60% and with a recurrence rate of 26%. These figures are consistent with other studies of patients with tumors of the shoulder girdle 1‐6,15‐17 . However, with only two immediate deaths and 75% of patients surviving at least 2 years, a durable, functional reconstruction is imperative to optimize quality of life.…”

“…Delayed complications occured in 27% of patients, although the majority of these were minor wound healing issues. These complication rates are lower than many seen in the literature 1,2,4,11 . Larger defect size, increasing exposed critical structures, the need for a free flap, and increased operative length all increased the risk of immediate complications as expected.…”

“…In comparison, previous reconstructive algorithms regarding this area have largely focused on a specific tumor type or specialty presentation, such as Malawer's description of orthopedic resections of sarcoma and thoracic surgery extirpative classifications of invasive chest wall tumors 2,11‐14 . These algorithms are not applicable to all oncologic resections in the UT‐SG region and leave uncertainty as to when advanced reconstructive techniques are best employed.…”

“…This has led to fragmentation of the surgical literature and limited development of more global reconstructive strategies. In addition, as the indications for amputation vs limb‐sparing surgeries have changed over the years, the types of cases presenting for reconstruction have shifted, providing new challenges and opportunities 1‐3 …”

Mimickers of Hill-Sachs Lesions

“…49 Malignant neoplasms can occur anywhere at the proximal humerus including at the diaphysis and metaphysis of the proximal humerus, in addition to involvement of the humeral head, surgical and anatomic necks, and greater and lesser tuberosities. 49 -51…”