Infected Tumor Prostheses

Abstract

Infection of tumor prostheses has been a major concern because of the extensive soft tissue dissection, long operating times, and patients' immunosuppression by cancer and adjuvant treatments. Infections most often present within 2 years postoperatively, with approximately 70% of postoperative deep infections presenting within 12 months after surgery. They are typically low organism burden infections, the pathogenesis of which is related to bacteria growing in biofilms. Staphylococci are the most common pathogens involved in prosthetic joint infections, accounting for approximately 50% of infections overall, followed by streptococci, enterococci, Enterobacteriaceae species, Pseudomonas aeruginosa, and anaerobe species. Multiple pathogens may be isolated in approximately 25% of cases, with the most common combination being coagulase-negative Staphylococcus and group-D Streptococcus. Early diagnosis and appropriate treatment are necessary. However, diagnosis may be challenging because clinical symptoms are highly variable and numerous preoperative and intraoperative diagnostic laboratory tests are nonspecific. In most cases, a 1- or 2-stage revision surgery is necessary for eradicating the megaprosthetic infection. Prevention of infection is important. The future will see technical advances for infections of tumor prostheses in areas such as microbiological diagnostics and biofilm-resistant prostheses.

Coagulase-Negative Staphylococci

“…PJIs have traditionally been divided into early infections, occurring within 4 weeks postoperatively (class I), those occurring between 4 weeks and 2 years postoperatively (class II), and late infections, occurring thereafter (class III) (133) (for current classification, see the website of the American Association of Orthopedic Surgeons). The last stage, showing more subtle signs of inflammation, chronic persistent postoperative pain, and implant loosening (low-grade PJIs), is more commonly associated with CoNS (134). In a retrospective cohort study conducted across 10 hospitals over a 3-year period, CoNS were isolated from 24% of culture-positive PJIs; 89% of these were methicillin-resistant strains (129).…”

Hemicortical Resection and Inlay Allograft Reconstruction for Primary Bone Tumors

“…We did not use muscle flaps; however, muscle transfers may be useful to reduce the risk of infection in these cases 39 . The infection rate was associated with the extent of cortical resection; it is conceivable that extensive resections require more soft-tissue dissection and take longer, thereby increasing the infection risk 40 .…”

Huge mediastinal liposarcoma resected by clamshell thoracotomy: a case report

“…The WHO defines four histologic liposarcoma subtypes, namely, well-differentiated, myxoid, dedifferentiated, and pleomorphic [4]. Well-differentiated liposarcomas or atypical lipomatous tumors require complete excision because of the high risk of local recurrence [6]. Two recent studies both reported that these tumors have 5-year local recurrence rates of approximately 50% [7, 8].…”