[Upper-extremity amputation in tumours of the shoulder and upper arm--experiences of the Vienna Bone Tumour Registry].
Malignant lesions of the bones and soft tissues require radical or wide resection to achieve adequate therapy. Due to the many developments in terms of adjuvant modalities, diagnostics and surgical expertise today there are several modes of therapy as alternatives to amputation in the treatment of malignant tumours of the shoulder and upper arm. After resection of smaller tumours excellent functional results can be obtained by the use of modular endoprostheses, whereas large neoplasms adjacent to the neurovascular bundle require resection-replantation to allow salvage of the hand. Within the Vienna Bone Tumour Registry, 100 patients out of a total of more than 6500 have been treated for such lesions: 62 received an endoprostheses, 18 resection-replantation and 20 amputation. In cases of primary malignant tumours the incidence of lung metastases was higher in the resection-replantation group (50 %) and amputation group (42 %) than in the prostheses group (11 %), which has been linked to larger tumour size in the former two groups. Radical or wide resections were obtained in 95 % of the prostheses group, as compared to 75 % and 78 % in the amputation group and the resection-replantation group, respectively, due to invasion into the neurovascular bundle. Over time the number of amputations decreased simultaneously with the increase of endoprostheses whereas the number of resection-replantations remained equal at our institution. Amputation today still plays a crucial role in the treatment of intralesionally resected tumours, as surgical contamination can make limb salvage impossible. Therefore, the importance of biopsy in the therapeutical algorithm of bone and soft tissue tumours has to be emphasised again.
Funovics
P T
PT
Universitätsklinik für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, Vienna, Austria. philipp.funovics@meduniwien.ac.at
Dominkus
M
M
Kotz
R
R
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000671:Amputation, Surgical; D001132:Arm / Q000601:surgery*; D001186:Artificial Limbs; D001317:Austria; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006811:Humerus / Q000601:surgery; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000601:surgery; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D011859:Radiography; D012042:Registries; D012086:Reoperation; D012092:Replantation / Q000379:methods; D012509:Sarcoma / Q000601:surgery; D012782:Shoulder / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000601:surgery*