Limb salvage surgery for children and adolescents with malignant bone tumors in a developing country.
OBJECTIVE
To describe the 5-year experience of a multidisciplinary limb salvage program for children and adolescents with malignant bone tumors in Lebanon.


METHODS
Between January 2002 to February 2007, 30 children and adolescents (2 with Ewing sarcoma and 28 with osteosarcoma) underwent Limb Salvage Surgeries (LSS) at the American University of Beirut Medical Center after partnering with the multidisciplinary team at St. Judes Children's Research Hospital (SJCRH). Procedures performed included 12 Repiphysis, noninvasively expandable, prostheses inserted in skeletally immature children, 15 modular prostheses, 2 allografts and 1 rotationplasty. All patients received pre- and postoperative chemotherapy.


RESULTS
With a mean follow-up of 31 months, 20 patients are now off therapy, 4 died, and 6 are receiving chemotherapy (3 due to pulmonary recurrence). Complications of surgery included infections in three cases, failure of the expansion mechanism in two, femoral stem fracture in one, prostheses femoral stem loosening in one and wound dehiscence in one. Lengthening of Repiphysis prostheses was achieved by subjecting the limb to an electromagnetic field that would allow controlled release of the Repiphysis expansion mechanism. Ten patients underwent a total of 42 lengthening procedures with an average of 9 mm lengthened per procedure (range 2-15 mm). All patients have good function of the affected limb.


CONCLUSIONS
Our LSS results are comparable to those reported in the literature. Collaboration with SJCRH and fund raising were critical to the program's success. This endeavor could serve as a model for establishing LSS programs in developing countries.
Haidar
Rachid
R
Children's Cancer Center of Lebanon, American University of Beirut-Medical Center, Beirut, Lebanon. rh00@aub.edu.lb
Sagghieh
Said
S
Muwakitt
Samar
S
Mumtaz
Ghina
G
Akel
Samir
S
Kamzoul
Rami
R
Farah
Roula
R
Noun
Peter
P
Khalifeh
Hassan
H
Farhat
Fadi
F
Razzouk
Bassem
B
Rodriguez Galindo
Carlos
C
Rao
Bhaskar
B
Abboud
Miguel R
MR
D000293:Adolescent; D000328:Adult; D001852:Bone Lengthening; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D003906:Developing Countries; D005121:Extremities / Q000601:surgery; D005260:Female; D006801:Humans; D007861:Lebanon; D023821:Limb Salvage; D008297:Male; D012516:Osteosarcoma / Q000601:surgery*; D012512:Sarcoma, Ewing / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult