Extra‐articular resection of shoulder joint for bone sarcomas: Oncologic and limb‐salvage outcomes of 32 cases compared with shoulder disarticulation and forequarter amputation

Abstract

Background and Objectives We aimed to identify the overall survival (OS), surgical complications, survival of reconstruction, and functional outcome of patients who underwent extra‐articular resection of the shoulder joint for primary bone sarcomas. The OS and local recurrence rates in patients who underwent an amputation were also evaluated for comparison. Methods Thirty‐two patients treated between 1988 and 2017 were studied. The tumours were located in the humerus in 22 (69%) and scapula in 10 patients (31%). The resection types were Malawer type IV in 6 (19%), type V in 21 (66%), and type VI in 5 patients (15%). Reconstruction was performed with endoprosthesis in 23 patients (72%) while excision arthroplasty with the suspension of the humerus to the clavicle was performed in 9 patients (28%). Surgical margins were wide in 16, marginal in 8, intralesional in 3, and not available in 5 patients. During the study period, 40 patients underwent a forequarter amputation and 11 patients underwent a shoulder disarticulation. Results The 5‐year OS for patients who underwent extra‐articular resection of the shoulder joint was 42% which was not statistically different compared with that of patients who underwent amputation (5‐year OS = 30%; P = .091). The 5‐year survival of the reconstruction was 94%, similar for endoprosthesis and excision arthroplasty. Local recurrence and complications developed in 6 (19%) and 10 patients (31%), respectively. Failures of the reconstruction requiring revision surgery occurred in two patients (6%). Limb salvage was achieved in 30 patients (94%). The median Musculoskeletal Tumour Society functional score was 61% (interquartile range, 57%‐70%) and was similar in the endoprosthesis and excision arthroplasty group. Conclusions Extra‐articular resection of the shoulder joint for bone sarcomas is an effective limb‐salvage method. However, local recurrence remains a principal concern.

Extra-articular resection of the hip joint for pelvic sarcomas: Are there any oncological and functional risks compared with intra-articular resection?

“…EARs of the knee and shoulder joint in patients with sarcomas are known to be associated with an increased risk of local failure, complications, and subsequent failure of limb-salvage [1] , [2] , [26] , [27] , [28] . However, little is known about the oncological and functional risk of EARs of the hip joint in patients with sarcomas.…”

Recurrent Malignant Peripheral Nerve Sheath Tumor Presenting As an Asymptomatic Intravenous Thrombus Extending to the Heart: A Case Report

“…Seventy percent of the cases indicated for forequarter amputation are sarcomas, such as undifferentiated pleomorphic sarcoma, osteosarcoma, and synovial sarcoma, while the others are breast cancers and melanomas [35]. According to recent reports, the overall 5-year survival rate after forequarter amputation for malignant tumors of the shoulder girdle is approximately 20-40% [34][35][36][37][38][39] (Table 1). Complications after forequarter amputation include massive blood loss, wound necrosis, dissection, pneumonia, and atelectasis [34,35,38].…”

High incidence of complications associated with shoulder girdle reconstruction utilizing a Stryker proximal humerus cap endoprosthesis following Tikhoff-Linberg resections

“…Subluxation and skin erosion are reported complications of early implants used to stabilize the arm on the remaining clavicle or scapula and chest wall [22,23]. In order to reduce the incidence of subluxation, various mesh and graft combinations have been used to enhance soft tissue reconstruction around the endoprosthesis [12,[24][25][26][27][28]. The proximal humerus cap prosthesis was designed to include multiple holes to pass suture/tape in an attempt to stabilize the implant to the remaining bony structures and soft tissue.…”

“…The mean age and body mass index (BMI) of this group was 67 ± 11 years and 27.5 ± 7.8 kg/m 2 . The resections all involved the scapula and were classified based on the system by Malawer [12] as partial scapulectomy, with maintenance of the glenoid (Type II; n = 7, 21%), total scapulectomy including the glenoid (Type III; n = 6, 18%), extra-articular scapular and humeral head resection (Type IV; n = 6, 18%), extraarticular humeral and glenoid resection (Type V; n = 11, 33%), or extra-articular humeral and total scapular resection (Type VI; n = 3, 9%). There were no isolated proximal humerus resections (Type 1) in this study.…”

“…Although limb salvage surgery is the treatment of choice, it is technically challenging from both an oncological and reconstructive perspective [1][2][3][4][5][6]. Currently, there are limited options to reconstruct the shoulder girdle in the setting of a combined resection of the proximal humerus and scapula (classic Tikhoff-Linberg) including a functional spacer, constrained scapular prosthesis, or a flail arm [1,4,5,[7][8][9][10][11][12].…”