Page 12 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 1
General Introduction
Historical Background & Aim of the Thesis
Primary bone tumors are rare, accounting for only 0.2% of the total human tumor burden1. In 1879, Samuel Weissel Gross published what was later referred to as the “ rst comprehensive work on bone sarcoma”2, 3. In this landmark paper, he advocated early amputation for high-grade sarcoma of bone and soft tissues, despite an overall operative mortality of 30%. Amputations at that time were also frequently performed to control local tumor growth, for palliation, because sarcomas often grew to enormous sizes before diagnosis4 ( gures 1 and 2).
Figure 1: A tumor of the humerus in a 16-year-old woman, four years after onset (from William Gibson, The Institutes and Practice of Surgery [Philadelphia: Carey & Lea, 1832], volume 1, facing page 248.)
Amputation long remained the principal treatment for bone sarcoma5. In 1940, Dallas Burton Phemister noted that “the proper treatment of bone sarcomas of the limbs without demonstrable metastases in the great majority of cases is amputation”6. Despite the aggressive and mutilating surgical approach at that time, the 1938 statistics of the Registry of Bone Sarcoma of the American College of Surgeons showed a mere 13% recurrence-free survival at a minimum follow-up of ve years in patients with osteosarcoma6.
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