Tumor Surgery

Mehmet Bartu SARISÖZENa , Cenk ERMUTLUa

aBursa Uludağ University Faculty of Medicine, Department of Orthopedics and Traumatology, Bursa, Türkiye

ABSTRACT
Complications may arise in any stage of treatment of musculoskeletal tumors, even before initial diagnosis. The first clinical manifestation of a lesion may be a complication such as a pathological fracture. In addition to general complications encountered in the treatment of adult patients, children are prone to additional complications due to remaining growth. Tumors may cause growth disturbance or deformity by destruction of the physis, altered biomechanics and metabolic activity. With the advances in chemotherapy and implant technology, wide resection and reconstruction has replaced amputation whenever possible. Resection of large bone segments or sacrifice of growth plate during surgery will also result in limb length discrepancy, which will be progressive in a child with growth remaining. Several options are available for reconstruction and growth disturbance. However, these procedures also have implant related complications that may cause delayed healing or repeating surgeries.
Keywords: Complications; fractures, bone; osteogenesis, distraction; neoplasms

Referanslar

  1. Herring JA. General Principles of Tumor Management. Tachdjian's Pediatric Orthopaedics From the Texas Scottish Rite Hospital for Children. 6th ed. PA, Philadelphia: Elsevier; 2022.
  2. Ozger H, Bulbul M, Eralp L. Complications of limb salvage surgery in childhood tumors and recommended solutions. Strategies Trauma Limb Reconstr. 2010;5(1):11-5. [Crossref]  [PubMed]  [PMC]
  3. Yang L, Wang D, Zuo J, Yang P, Tang X, Yang X. Pathological fracture increases the risk of unsatisfactory functional results and avascular necrosis in children with proximal femur simple bone cysts. Injury. 2024;55(3):111068. [Crossref]  [PubMed]
  4. Patterson JT, Tangtiphaiboontana J, Pandya NK. Management of Pediatric Femoral Neck Fracture. J Am Acad Orthop Surg. 2018;26(12):411-9. [Crossref]  [PubMed]
  5. Canavese F, Samba A, Rousset M. Pathological fractures in children: Diagnosis and treatment options. Orthop Traumatol Surg Res. 2016;102(1 Suppl):S149-59. [Crossref]  [PubMed]
  6. van Geloven TPG, van der Heijden L, Laitinen MK, Campanacci DA, Döring K, Dammerer D, et al.; EPOS Study Group. Do's and Don'ts in Primary Aneurysmal Bone Cysts of the Proximal Femur in Children and Adolescents: Retrospective Multicenter EPOS Study of 79 Patients. J Pediatr Orthop. 2023;43(1):37-45. [Crossref]  [PubMed]  [PMC]
  7. Tang N, Song WX, Luo J, Haydon RC, He TC. Osteosarcoma development and stem cell differentiation. Clin Orthop Relat Res. 2008;466(9):2114-30. [Crossref]  [PubMed]  [PMC]
  8. Zöllner SK, Amatruda JF, Bauer S, Collaud S, de Álava E, DuBois SG, et al. Ewing Sarcoma-Diagnosis, Treatment, Clinical Challenges and Future Perspectives. J Clin Med. 2021;10(8):1685. [Crossref]  [PubMed]  [PMC]
  9. Aponte-Tinao LA, Albergo JI, Ayerza MA, Muscolo DL, Ing FM, Farfalli GL. What Are the Complications of Allograft Reconstructions for Sarcoma Resection in Children Younger Than 10 Years at Long-term Followup? Clin Orthop Relat Res. 2018;476(3):548-55. [Crossref]  [PubMed]  [PMC]
  10. Cashin M, Coombs C, Torode I. A-Frame free Vascularized Fibular Graft and Femoral Lengthening for Osteosarcoma Pediatric Patients. J Pediatr Orthop. 2018;38(2):e83-e90. [Crossref]  [PubMed]
  11. Hopyan S. Reconstruction for bone tumours of the shoulder and humerus in children and adolescents. J Child Orthop. 2021;15(4):358-65. [Crossref]  [PubMed]  [PMC]
  12. Arteau A, Lewis VO, Moon BS, Satcher RL, Bird JE, Lin PP. Tibial Growth Disturbance Following Distal Femoral Resection and Expandable Endoprosthetic Reconstruction. J Bone Joint Surg Am. 2015;97(22):e72. [Crossref]  [PubMed]  [PMC]
  13. Tsuda Y, Fujiwara T, Sree D, Stevenson JD, Evans S, Abudu A. Physeal-preserving endoprosthetic replacement with short segment fixation in children with bone sarcomas. Bone Joint J. 2019;101-B(9):1144-50. [Crossref]  [PubMed]
  14. Capanna R, Campanacci DA, Belot N, Beltrami G, Manfrini M, Innocenti M, et al. A new reconstructive technique for intercalary defects of long bones: the association of massive allograft with vascularized fibular autograft. Long-term results and comparison with alternative techniques. Orthop Clin North Am. 2007;38(1):51-60, vi. [Crossref]  [PubMed]
  15. Bae DS, Waters PM, Gebhardt MC. Results of free vascularized fibula grafting for allograft nonunion after limb salvage surgery for malignant bone tumors. J Pediatr Orthop. 2006;26(6):809-14. [Crossref]  [PubMed]
  16. Tsuchiya H, Shirai T, Morsy AF, Sakayama K, Wada T, Kusuzaki K, et al. Safety of external fixation during postoperative chemotherapy. J Bone Joint Surg Br. 2008;90(7):924-8. [Crossref]  [PubMed]
  17. Lesensky J, Prince DE. Distraction osteogenesis reconstruction of large segmental bone defects after primary tumor resection: pitfalls and benefits. Eur J Orthop Surg Traumatol. 2017;27(6):715-27. [Crossref]  [PubMed]
  18. Goldwein JW. Effects of radiation therapy on skeletal growth in childhood. Clin Orthop Relat Res. 1991;(262):101-7. [Crossref]
  19. El Ghoneimy AM, Shehab AM, Farid N. What is the Cumulative Incidence of Revision Surgery and What Are the Complications Associated With Stemmed Cementless Nonextendable Endoprostheses in Patients 18 Years or Younger With Primary Bone Sarcomas About the Knee. Clin Orthop Relat Res. 2022;480(7):1329-38. [Crossref]  [PubMed]  [PMC]
  20. Futani H, Minamizaki T, Nishimoto Y, Abe S, Yabe H, Ueda T. Long-term follow-up after limb salvage in skeletally immature children with a primary malignant tumor of the distal end of the femur. J Bone Joint Surg Am. 2006;88(3):595-603. [Crossref]  [PubMed]
  21. Cipriano CA, Gruzinova IS, Frank RM, Gitelis S, Virkus WW. Frequent complications and severe bone loss associated with the repiphysis expandable distal femoral prosthesis. Clin Orthop Relat Res. 2015;473(3):831-8. [Crossref]  [PubMed]  [PMC]