Hemicortical Excision for Low-grade Selected Surface Sarcomas of Bone

Abstract

In malignant surface tumors, hemicortical excision in select cases may allow adequate margins with better function. We treated 10 of 22 malignant surface tumors with hemicortical excision and reconstruction from January 2000 to June 2003. There were eight conventional parosteal osteosarcomas, one high-grade surface osteosarcoma, and one surface chondrosarcoma. Six tumors occurred in the femur, two in the tibia and one each in the humerus and radius. Defects were reconstructed with allograft (five), fibula autograft (three), or autogenous iliac crest (two). Internal fixation as suitable was used. Margins were reported uninvolved in all cases. At followup ranging from 40 months to 61 months we observed no local recurrence. Using the MSTS scoring system, six patients had a maximum possible score of 30; the other four had a score of 29. None developed distant metastasis. Though a longer followup is ideal, in selected cases hemicortical excision appears a reasonable procedure that obviates joint replacement. Biological reconstruction with bone could help reduce the incidence of subsequent revision surgery that would likely occur in cases treated initially with conventional excision and replacement with megaprostheses or circumferential intercalary allografts.

Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

“…With the navigation guidance, we could reproduce the planned resection without any help of landmark measurements or intraoperative fluoroscopy. Some authors have reported the use of multiplanar osteotomies or hemicortical resection to treat select patients with bone sarcoma [1,3,5]. Our results in Patients 1, 5, 6, and 8 also suggest multiplanar osteotomies or hemicortical resection are possible around bone tumors.…”

Multiplanar Osteotomy with Limited Wide Margins: A Tissue Preserving Surgical Technique for High-grade Bone Sarcomas

“…One study of 237 patients with high-grade osteosarcomas reported only 11% of patients who had local recurrences were living at the most recent followup [25]. Given the high risk of local recurrence with a contaminated margin [2] and the resulting poor prognosis, many physicians are reluctant to perform a resection that achieves less than generously wide margins [1,2]. In contrast, some authors have reported no local recurrences and no nonunions, with a resection technique used for low-grade surface osteosarcomas that retains part of the cortical circumference [1,8,19].…”

Limb Salvage for Osteosarcoma: Current Status with a Review of Literature

“…For high grade sarcomas, a wide margin is considered adequate and will achieve successful control of the primary tumor approximately 95% of the time, whereas marginal or intralesional margins are associated with higher rate of local recurrence and poor outcomes 26 . For bone 3cm away from the extent on T1-MRI image is adequate [27][28][29][30][31][32] . The marrow is always sent from the cut end for frozen section evaluation for tumour.…”

“…We reported our results in ten cases with complete incorporation of the graft in all the cases and no local recurrence. 28 Fig. 2.…”

“…Reconstruction of these defects can be done by a shaped allograft or by fibula or iliac crest strut autograft. 28 Because of the large contact area and vascularity of the bed, usual complications associated with allografts like infection, nonunion and fracture are rare. We reported our results in ten cases with complete incorporation of the graft in all the cases and no local recurrence.…”