43 research outputs found

    Local Excision Without Radiation for High-Grade Soft-Tissue Sarcoma of the Extremity and Superficial Trunk

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    Purpose. Limb-sparing surgery combined with radiation treatment has become the accepted treatment for patients with high-grade soft-tissue sarcoma. Adjuvant radiation was not routinely used at this institution for patients with clear margins after surgery.This retrospective review analyses the outcome of this group of patients

    Clinical outcomes after vascular reconstruction using synthetic grafts for limb salvage in patients with lower extremity sarcoma: a single-center retrospective experience

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    IntroductionLimb-salvage surgery has become the mainstream approaches for the treatment of sarcoma in the lower extremity. In cases where the sarcoma infiltrates the primary vessel, concurrent resection of the vessels and vascular reconstruction are required to ensure sufficient resection and preservation of limb function. The objective of this study is to assess the clinical outcomes of patients who underwent vascular reconstruction utilizing synthetic grafts for limb salvage, specifically in terms of postoperative complications and limb functional status.MethodsBetween September 2016 and October 2021, 15 consecutive patients who underwent 15 arterial and 3 venous reconstruction procedures were included in this retrospective study. Incidence of postoperative morbidity, graft patency, rate of limb salvage, and overall survival of patients were analyzed.ResultsThe median follow-up was 12.5 months (range, 4.5-72.0). Graft thrombosis occurred in 5 patients (33.3%) and graft occlusion occurred in 3 patients (20.0%). The median overall survival was 28.0 months with the estimated 2-year and 5-year overall survival of 57.8% and 43.4% respectively. The 1-year and 2-year estimated patency rates of arterial reconstructions were 82.3% and 62.1%, respectively. None of the included patients with limb amputation were observed as a consequence of severe vascular complications, while two patients underwent amputation due to the repeat recurrence, resulting in a limb salvage rate of 86.7%.ConclusionOur results show that the combination of vascular reconstruction and oncologic resection is a feasible option for preserving limbs in cases of musculoskeletal sarcoma with vessel involvement in the lower extremity. When vascular reconstruction surgery is performed, synthetic substitutes can be effectively used with low perioperative morbidity and an acceptable rate of limb salvage

    A Study on limb sparing surgery on extremity soft tissue sarcoma.

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    INTRODUCTION : Soft tissue sarcomas are the most frequent sarcomas. They are a rare and heterogeneous group of tumors that arise from the supporting extra skeletal tissues (i.e., muscle, fascia, nerve, connective, fibrous, and fatty tissues. Although soft tissues comprise 75% of the average body weight, these neoplasms represent less than 1% of all adult and 15% of pediatric malignancies. Soft tissue sarcomas are a disease of adulthood, occurring most commonly in persons between 30 and 60 years of age. The sole exception is rhabdomyosarcoma, which occurs in young children. Each of the various soft tissue sarcomas has a unique morphology, biological behavior, and prognosis. However, like bone sarcomas, they all share certain biological and behavioural characteristics. The clinical, radiographic, and surgical management of most soft tissue sarcomas is identical, regardless of histogenesis. The treatment of soft tissue sarcoma has become multidisciplinary, as advances in biology, imaging, surgery, chemotherapy and radiotherapy have improved the outlook for these patients who have these malignancies. AIM : 1. To study the incidence of soft tissue sarcoma in our institution. 2. To study the rate of limb sparing surgery and amputations. 3. To study age distribution and sex incidence. 4. To study the presentations of soft tissue sarcoma on diagnosis. 5. To study stage of the disease at presentation. 6. To study the incidence of various pathological types. 7. To study the surgical management, reconstruction techniques, complications and their management. 8. To study the functional outcome after limb sparing surgery. 9. To study the oncological outcome after limb sparing surgery. CONCLUSION : Soft tissue sarcomas are the most frequent sarcomas. They are a rare and heterogeneous group of tumors representing 1.64% of all adult malignancies in this series. They are a disease of adulthood, occurring most commonly in persons between 30 and 60 years of age. Incidence in male is lower (male: female ratio – 1.5:1) in this series than reported in other series (ratio 4:1) In this study, 81% of patients are suitable for limb sparing surgery and 19% of patients required amputation. This somewhat higher rate of amputation compared to international series is due to large tumor size and late presentation of our patients. In this study, pain is the symptom that draws the patient to seek medical attention and most of the swellings are more than 5 cm in size. So, any soft tissue mass in an adult that is symptomatic or enlarging, any mass that is larger than 5 cm or any new mass that persists beyond 4 weeks is should be considered as soft tissue sarcoma and investigated definitively. Evaluation for metastatic disease in the lungs should be done once a soft tissue sarcoma is diagnosed since one third of patients are metastatic at presentation in this study comparable to other studies. 84% of patients had T2b tumor that is deep tumor with size of more than 5 cm. Liposarcoma is the commonest histology comparable to other studies. In comparison with preoperative histology, there is 26% of discordance rate comparable to international series. Limb-sparing surgery is now the standard of care for bone and soft tissue sarcomas of the extremities and is performed in approximately 90% of all cases. All patients must be considered and evaluated for limb-sparing surgery, and the decision to proceed with an amputation should be made on a case-by-case basis. Such decisions are based on local anatomic considerations, tumor grade and stage, and consideration of the functional and psychological impact of the procedure

    Surgical outcome of Musculoskeletal Tumors of Pelvis.

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    INTRODUCTION : The bony pelvis and its enveloping soft tissues are a common site for bone and soft-tissue tumors. Five percent of primary malignant bone tumors involve the pelvis. Osteosarcoma in adolescents, Ewing’s sarcoma in children and chondrosarcoma in adults are the most common primary sarcomas in this location. More commonly, though, neoplasms involving the pelvis occur as a result of metastatic spread from the breast, lung, prostate, kidney or thyroid. Until the late 1970s most pelvic tumors were treated with External hemipelvectomy, a procedure that was associated with a significant percentage of complications and a dismal functional and psychological outcome. The 1st successful hemipelvectomy was reported by Charles Girard in 1895, for a recurrent osteosarcoma. With the advent of more accurate imaging modalities, newer chemotherapeutic agents, use of neoadjuvant chemotherapy, improved resection techniques, and prosthetic reconstruction, limb sparing procedures are now performed in the majority of these cases. Extensive pelvic surgeries are highly demanding because of the irregular and complex shape of the bony pelvis, numerous muscle attachments, and the proximity of major blood vessels, nerves, and visceral organs. Given the complexity of the anatomy and the use of adjuvant therapies that require an uncomplicated and expedient postoperative recovery, osseous pelvic resections remain one of the greatest surgical challenges. AIM : To analyze the surgical management of musculoskeletal tumors in pelvis. To analyze the morbidity & mortality associated with the management of musculoskeletal tumors in pelvis. To analyze the oncological & functional outcome of musculoskeletal tumors in pelvis and compare with that of literature. CONCLUSION : Bone and soft-tissue sarcomas that arise in the pelvis are difficult to treat. Tumors can be large and destructive before discovery, and they often involve vessels and nerves. Achieving a wide or even a marginal surgical resection margin may be technically complex at times. Historically, patients with pelvic tumors were treated with hemipelvectomies. These operations not only were fraught with complications but also in most cases represented physical, functional, and psychological problems for the patients. Several studies have described the difficulties patients have with such a procedure, and there is little doubt that regardless of the problems associated with the internal hemipelvectomies and reconstructions, such procedures are preferred to total limb ablation. Sacrectomy, one of the neglected & morbid operations, is feasible now with modified and improved surgical techniques

    Patient survival after surgical resection of pelvic bone sarcomas: A nationwide cohort study

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    Background: Pelvic bone sarcomas are extremely rare malignant tumours. Patients require a multidisciplinary approach to plan the treatment and complex surgical resections and limb-sparing reconstructions associated with complications, revisions, and functional limitations. The presented nationwide study in the Republic of Slovenia aims to analyse the oncological survival and functional outcomes of patients after primary resection of pelvic bone sarcomas. Methods: The retrospective observational cohort included 21 consecutive patients who underwent limb-sparing pelvic resection at a specialized orthopaedic oncology centre in the Republic of Slovenia between 2004-2022. Patient survival, complication rates, and functional outcomes were analysed according to to the primary diagnosis. Results: Wide margins with R0 resection were achieved in 16 (76%) cases. After a median follow-up of 5.7 (0.6-18.1) years, 7 (33%) patients died of oncological disease, 3 (14%) patients were alive with oncological disease, and 11 (53%) patients were alive with no evidence of disease. The estimated Kaplan-Meier survival probability at 2 years, 5 years, and 10 years after pelvic resection was 85%, 73%, and 45%, respectively. The major complication rate was 29%. The mean Musculoskeletal Tumour Society Score was 17.5 (range 2-29). Conclusions: Patient survival after resection of pelvic bone sarcomas in Slovenia between 2004-2022 is comparable to previously published reports of European and North American countries. Wide resection of tumours with reconstruction provides a relatively good survival rate, although complications are common and functional outcomes are often poor

    Biology and technology in the surgical treatment of malignant bone tumours in children and adolescents, with a special note on the very young

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    Purpose: The main challenge in reconstruction after malignant bone tumour resection in young children remains how and when growth-plates can be preserved and which options remain if impossible.Methods: We describe different strategies to assure best possible long-term function for young children undergoing resection of malignant bone tumours.Results: Different resources are available to treat children with malignant bones tumours: a) preoperative planning simulates scenarios for tumour resection and limb reconstruction, facilitating decision-making for surgical and reconstructive techniques in individual patients; b) allograft reconstruction offers bone-stock preservation for future needs. Most allografts are intact at long-term follow-up, but limb-length inequalities and corrective/revision surgery are common in young patients; c) free vascularized fibula can be used as stand-alone reconstruction, vascularized augmentation of structural allograft or devitalized autograft. Longitudinal growth and joint remodelling potential can be preserved, if transferred with vascularized proximal physis; d) epiphysiolysis before resection with continuous physeal distraction provides safe resection margins and maintains growth-plate and epiphysis; e) 3D printing may facilitate joint salvage by reconstruction with patient-specific instruments. Very short stems can be created for fixation in (epi-)metaphysis, preserving native joints; f) growing endoprosthesis can provide for remaining growth after resection of epi-metaphyseal tumours. At ten-year follow-up, limb survival was 89%, but multiple surgeries are often required; g) rotationplasty and amputation should be considered if limb salvage is impossible and/or would result in decreased function and quality of life.Conclusion: Several biological and technological reconstruction options must be merged and used to yield best outcomes when treating young children with malignant bone tumours.Orthopaedics, Trauma Surgery and Rehabilitatio
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