Page 127 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Table 3. Multivariable analysis for factors of in uence on the occurrence of complications.
Complications and covariable(s)
All non-oncological complications (types I-IV) (n = 37; 33%)
25%-50% 51%-75% >75%
Fracture of host cortex (n = 20; 18%)
25%-50% 51%-75% >75%
Nonunion of allograft-host junctions
OR 95% CI
p-value
Inlay allografts
1.6 0.6 - 4.3 0.33 <25% (reference) (1)
Reconstruction length ≥8 cm
% of cortical circumference resected
2.7 1.0 - 7.4 0.06 3.1 0.7 - 12.5 0.12 6.1 0.9 - 43.8 0.07
2.4 0.6 - 10.2 0.23 <25% (reference) (1)
Reconstruction length ≥8 cm
% of cortical circumference resected
4.4 0.8 - 23.4 0.08
5.2 0.7 - 38.8 0.11 15.1 1.5 - 146.5 0.02 7.5 1.5 - 37.9 0.02
16% (n = 10 — ve with an adamantinoma, four with a parosteal osteosarcoma, 6 and one with a grade 1 chondrosarcoma) had residual or recurrent tumor during
the follow-up period. Of the 22 with an intermediate-grade malignancy, 9% (two —
both with grade 2 chondrosarcoma) had residual or recurrent tumor, and the rate was
21% (three — Ewing sarcoma, leiomyosarcoma, and conventional osteosarcoma) in the 14 with a high-grade malignancy. For the 97 patients with a malignant lesion, the risk of experiencing a residual or recurrent tumor was signi cantly higher if adequate margins had not been obtained during the index procedure (OR = 14.4) (table 2). All patients with residual or recurrent tumor had secondary surgery. In seven (6%) of the 97 patients, the residual or recurrent tumor was resected without violating the reconstruction: four soft-tissue recurrences, two recurrences in the same bone but outside the allograft, and one residual tumor (a parosteal osteosarcoma, diagnosed on imaging one day postoperatively, after resection the allograft was put back in place). In the remaining eight patients (8%), the allograft was removed, after a median of 17 months (7 months to 13 years); four had a secondary reconstruction and four underwent an ablative procedure ( gure 3).
Metastasis was diagnosed in six patients (6% of the patients with a malignant lesion), two with grade 2 chondrosarcoma, two with Ewing sarcoma, one with leiomyosarcoma, and one with periosteal osteosarcoma, after a median of 15 months (2 to 47).
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