Page 128 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 6
Table 4. Residual or recurrent malignant tumors and ablative surgery, strati ed according to grade of malignancy and surgical margins.
Grade of malignancy and margins No. obtained
Low-grade 61 Adequate 50 Questionable 4 Intralesional 7†
Intermediate-grade 22 Adequate 16 Questionable 5 Intralesional 1
High-grade 14 Adequate 11 Questionable 1 Intralesional 2
% No.
100 10 82 4 7 1 11 5 100 2 73 0 23 1 5 1 100 3 79 1 7 1 14 1
%
16 8 25 71 9
Total
Residual or recurrent malignant tumor
Ablative surgery
No. %
1 2 1 2 0 - 0 - 1 5
-- - 20 0 - 100 1 100
21 3 21 9 1‡ 9 100 1 100 50 1 50
*The percentage of the corresponding group (with equal tumor grade and surgical margins). †One of these patients underwent secondary surgery due to an infection of the allograft; in the same procedure, an additional piece of bone was removed at the contaminated osteotomy site. ‡No attempt was made to resect the recurrent tumor; a below-the-knee amputation was performed because of a concomitant infection.
Failures and Allograft Survival
Fifteen allografts (14%) were removed: two (2%) for mechanical reasons (both nonunion), ve (5%) because of infection, and eight because of residual or recurrent tumor (8% of the patients with a neoplasm). Fourteen failures occurred within three years postoperatively, and the remaining patient had a recurrence after 13 years. With failure for any reason as the end point, estimated two- and ten-year allograft survival rates were 92% and 87%, respectively ( gure 4). Allograft survival was signi cantly worse for patients with an infection (HR = 10.4, 95% CI = 3.5 to 31.2, p < 0.001).
Ablative procedures were performed to treat four residual or recurrent tumors and one infection. The overall limb-salvage rate was 95% (n = 106). Ablative procedures were more frequent in patients with a high-grade lesion (OR = 13.0, 95% CI = 1.9 to 86.2, p = 0.008); for them, the limb-salvage rate was 79% (11 of 14).
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