Clin Orthop Surg.  2013 Sep;5(3):216-224. 10.4055/cios.2013.5.3.216.

Role of Surgical Margin on Local Recurrence in High Risk Extremity Osteosarcoma: A Case-Controlled Study

• Jeon DG
• Song WS
• Kong CB
• Cho WH
• Cho SH
• Lee JD
• Lee SY

• KMID: 1705548
• DOI: http://doi.org/10.4055/cios.2013.5.3.216

Abstract

BACKGROUND
The relationship between surgical margin and local recurrence (LR) in osteosarcoma patients with poor responses to chemotherapy is unclear. Moreover, the incidences of LR according to three different resection planes (bone, soft tissue, and perineurovascular) are not commonly known.
METHODS
We evaluated the incidence of LR in three areas. To assess whether there is a role of surgical margin on LR in patients resistant to preoperative chemotherapy, we designed a case (35 patients with LR) and control (70 patients without LR) study. Controls were matched for age, location, initial tumor volume, and tumor volume change during preoperative chemotherapy.
RESULTS
LR occurred at the soft tissues in 18 cases (51.4%), at the perineurovascular tissues in 11 cases (31.4%), and at the bones in six cases (17.2%). The proportion of inadequate perineurovascular margin was higher in the case group than in the control group (p = 0.01). Within case-control group (105 patients), a correlation between each margin status and LR at corresponding area was found in the bone (p < 0.001) and perineurovascular area (p = 0.001).
CONCLUSIONS
LR is most common in soft tissues. In patients showing similar unfavorable responses to chemotherapy, the losses of perineurovascular fat plane on preoperative magnetic resonance imaging may be a valuable finding in predicting LR.

Keyword

Osteosarcoma; Local recurrence; Surgical margin

MeSH Terms

Adolescent
Bone Neoplasms/*pathology/radiography/*surgery
Case-Control Studies
Chi-Square Distribution
Female
Humans
Male
Neoplasm Recurrence, Local/*pathology
Neoplasm, Residual/pathology
Osteosarcoma/*pathology/radiography/*surgery

Figure

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  Fig. 1 (A) Prechemotherapy T1 magnetic resonance imaging shows visible normal tissue plane between posterior tibial vessel and extra-osseous tumor mass. (B) After chemotherapy, the tumor volume increased and normal tissue plane between tumor and neurovascular bundle disappeared (inadequate margin in neurovascular area). (C) At 9 months postoperatively, local recurrence developed around inadequate margin of perineurovascular area.

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  Fig. 2 (A) Initial X-ray shows diaphyseal osteosarcoma of tibia. (B) Intercalary resection resulted in marginal resection at proximal osteotomy site. (C) Local recurrence developed in the area with inadequate bone margins 57 months postoperatively.

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  Fig. 3 (A) Prechemotherapy T2 magnetic resonance imaging of proximal humeral osteosarcoma shows intra-compartmental lesion. (B) The tumor showed extra-compartmental disruption on antero-lateral side after chemotherapy. (C) Although the whole deltoid muscle layer was excised with tumor, recurrence developed in widely resected soft tissue areas 36 months postoperatively.

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