Abstract

Objective

Limb-salvage following resection of bone sarcomas of the foot are challenging due to the complicated anatomy, adjacent neurovascular structures and few durable reconstruction options.

Methods

We retrospectively analysed 50 patients with primary malignant bone sarcoma of the foot who underwent surgery including chondrosarcoma (n = 23), Ewing’s sarcoma (n = 14) and osteosarcoma (n = 13).

Results

Median follow-up was 68 months. The primary sites were metatarsal (n = 18), phalanges (n = 15), calcaneus (n = 13) and others (n = 4). The 5-year disease-specific survivals were 100, 83 and 83% in chondrosarcoma, Ewing’s sarcoma and osteosarcoma, respectively. Below knee amputation, ray/toe amputation, excision and curettage were performed in 21, 24, 2 and 3 patients, respectively. Below knee amputation was performed in 94% of mid/hindfoot tumours. Surgical margins were wide/radical, marginal and intralesional margin in 42, 5 and 3 patients. Three patients (6%) developed local recurrence, whereas, local recurrence was not observed in patients with wide/radical margins. Postoperative complications occurred in 3 patients (6%; surgical site infection n = 2 and delayed wound healing n = 1). Mean MSTS functional score was 26 points (range, 19–30).

Conclusions

Good local control was achieved with acceptable functional outcomes and post-operative complications; almost all mid/hindfoot tumours required below knee amputation achieving wide/radical margins without local recurrence.

中文翻译：

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足部骨肉瘤的手术结果

摘要

客观的

由于复杂的解剖结构、相邻的神经血管结构和很少有持久的重建选择，足部骨肉瘤切除术后的保肢具有挑战性。

方法

我们回顾性分析了50例足部原发性恶性骨肉瘤接受手术的患者，包括软骨肉瘤（n  =23）、尤文氏肉瘤（n  =14）和骨肉瘤（n  =13）。

结果

中位随访时间为 68 个月。原发部位为跖骨（n  =18）、趾骨（n  =15）、跟骨（n  =13）等（n = 4）。软骨肉瘤、尤文肉瘤和骨肉瘤的 5 年疾病特异性存活率分别为 100%、83% 和 83%。分别对 21、24、2 和 3 名患者进行了膝以下截肢、射线/脚趾截肢、切除和刮宫。在 94% 的中/后足肿瘤中进行了膝下截肢。42、5 和 3 名患者的手术切缘为宽/根治性、边缘和病灶内切缘。三名患者 (6%) 出现局部复发，而在具有广泛/根治性边缘的患者中未观察到局部复发。3 名患者出现术后并发症（6%；手术部位感染n  = 2，伤口愈合延迟n  = 1）。平均 MSTS 功能评分为 26 分（范围，19-30）。

结论

局部控制良好，功能结果和术后并发症可接受；几乎所有的中/后足肿瘤都需要在膝盖以下截肢，以实现宽/根治性切缘而不会局部复发。