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Mid-term complication rate after limb salvage for pediatric bone sarcomas
Michael J Colello1,2, Abigail Padilla2, Annika Y Myers2
1Department of Orthopedic Surgery, Prisma Health-Upstate, Greenville, South Carolina.
Insights
Limb salvage surgery for pediatric bone sarcomas has a high complication rate, with 75% of patients experiencing issues. Surgeons must be prepared for frequent complications and reoperations in these young cancer patients.
Area of Science:
- Pediatric Orthopedic Oncology
- Surgical Reconstruction
- Oncology
Background:
- Limb salvage surgery is crucial for treating pediatric bone sarcomas.
- Understanding mid-term complications is vital for patient management.
Purpose of the Study:
- To detail the mid-term complication profile following limb salvage for pediatric bone sarcomas.
- To analyze complications across various reconstruction techniques.
Main Methods:
- Retrospective review of patients under 18 with primary bone sarcoma undergoing limb salvage.
- Stratification by reconstruction type: endoprosthetic, allograft, composite, biologic.
- Analysis of complication rates, types, timing, and reoperation frequency.
Main Results:
- Overall complication rate was 75%, with 36% major complications in 84 patients (median follow-up 46 months).
- 55% required reoperation, with 14% needing three or more.
- 71% experienced their first complication within 1 year; 28% had early reoperation within 12 weeks.
Conclusions:
- Limb salvage for pediatric bone sarcomas involves high complication and reoperation rates irrespective of technique.
- These procedures are integral to multidisciplinary care, necessitating preparedness for complications, especially during chemotherapy.
- Provides realistic expectations for postoperative outcomes in pediatric limb salvage patients.
Abstract:
The purpose of this study is to describe the mid-term complication profile after limb salvage for pediatric bone sarcomas utilizing all reconstruction techniques. A retrospective review was performed on patients less than 18 years who underwent resection of a primary bone sarcoma with limb salvage reconstruction. The primary outcome measure was the all-cause postoperative complication rate. Complications were grouped into major or minor categories. Patients were stratified by reconstruction type (endoprosthetic, allograft, allograft-prosthetic composite, biologic). The timing of complications and reoperations was analyzed. Eighty-four patients were included (median follow-up 46 months). The overall complication rate was 75%, and the major complication rate was 36%. Twenty-five percent had two complications, and 18% had three or more complications. The reoperation rate was 55%, and 14% required three or more reoperations. Seventy-one percent of patients sustained their first complication within 1 year. Twenty-eight percent of patients underwent a reoperation within 12 weeks. Limb salvage for pediatric bone sarcomas is associated with a high rate of complications and reoperations, regardless of reconstruction technique. Despite the substantial complication rate, these procedures are essential to the multidisciplinary care of children with bone sarcomas, as limb salvage is commonly pursued. We hope to provide realistic postoperative expectations and argue that surgeons caring for these patients must be prepared to manage complications, as they tend to arise during the window of adjuvant chemotherapy.