Indications for ablative surgery in extremity musculoskeletal tumours.
BACKGROUND
Surgical options for treatment of extremity musculoskeletal tumours include excision [limb sparing] surgery or amputation [limb ablation]. Ablative surgery is for advanced extremity musculoskeletal tumours when limb salvage surgery is not feasible.


OBJECTIVE
To determine the indications for ablative surgery in extremity musculoskeletal tumours in our centre.


METHODS
This is a 6 year prospective study of patients presenting with extremity musculoskeletal tumours at National Orthopaedic Hospital Lagos. Data such as age, gender, presenting complaints, anatomic location of the tumour, clinical stage, type of ablative surgery and adjuvant treatment offered, histologic type of tumour, and treatment outcome were documented.


RESULTS
Nineteen patients had ablative surgery as a mode of treatment. 11 were male while 8 were female with a M:F of 1.3:1. The age range was 3 - 69 years. Seven patients [6 males and 1 female] refused ablative surgery and voluntarily discontinued treatment. Most tumours were located in the lower limb and all patients that had ablative treatment presented with stage 3 or 4 disease. Osteogenic sarcoma was the most common diagnosis, accounting for 4 cases [21.1%]. Six patients [31.6%] with non-malignant tumours had ablative surgery due to either late presentation or inaccurate preoperative diagnosis. Trans-femoral amputation was the most common level of amputation and this was done in 9 patients [47.4%]. Adjuvant chemotherapy was prescribed for all patients. The recurrence and survival rates could not be determined for each tumour as the patients were lost to follow-up soon after surgery with average post operative follow up of 5.5 months.


CONCLUSIONS
Late presentation with locally advanced disease remains the dominant indication for ablative surgery in extremity musculoskeletal tumours.
Eyesan
S U
SU
Department of Orthopaedics and Trauma Surgery, National Orthopaedic Hospital, Lagos.
Obalum
D C
DC
Onovo
D O
DO
Ketiku
K K
KK
Abdulkareem
F B
FB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D001859:Bone Neoplasms / Q000145:classification / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006782:Hospitals, Special; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018213:Neoplasms, Bone Tissue / Q000145:classification / Q000473:pathology / Q000601:surgery*; D009549:Nigeria; D009985:Orthopedics; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome; D034941:Upper Extremity / Q000601:surgery*; D055815:Young Adult