J Korean Orthop Assoc.  2015 Dec;50(6):444-452. 10.4055/jkoa.2015.50.6.444.

Surgical Resection of Malignant Bone Tumors

• Jung ST
• Chung YW

• KMID: 2185085
• DOI: http://doi.org/10.4055/jkoa.2015.50.6.444

Abstract

Malignant bone tumors are less common than other tumors, and we often make a misdiagnosis. However, due to its severity and prognosis we should not pass over the malignant bone tumor, because it is one of the important diseases to diagnose. Specific techniques are available for the resection and reconstruction of malignant bone tumors from the body involving extremities. In particular, it is necessary to establish guidelines for elimination of tumor cells as much as possible and minimize the malfunction. Knowledge of the staging system and guide lines for resection margin is required for treatment of malignant bone tumors.

Keyword

bone neoplasms; diagnostic errors; extremities

MeSH Terms

Bone Neoplasms
Diagnostic Errors
Extremities
Prognosis

Figure

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  Figure 1 Surgical margin. Cited from the article of Enneking (Instr Course Lect. 1988;37:3-10)10) with original copyright holder's permission.

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  Figure 2 Surgical margin from Kawaguchi. The principle of curative wide resection is that, when a barrier exists, the tumor is removed outside the barrier. When a barrier is not present, the tumor is removed using as much margin as possible greater than 5 cm. (A) In case of a skin or subcutaneous lesion, the lesion is removed with a margin of 5 cm or more where the barrier does not exist and outside the barrier where it does exist. (B) If the lesion arises in an intermuscular area, the margin is more than 5 cm where there is no barrier. (C) In intramuscular lesions, the muscle surrounding the tumor is removed 5 cm from the reactive zone where a barrier does not exist, and the dissection and resection of the nearby tissues depends on the barrier rather than the true physical distance from the lesion. (D) In bone sarcoma, the tumor is removed 5 cm from the lesion if a barrier does not exist like the site of the nearby diaphysis of the bone but if a barrier exists the barriers are converted into equivalent distances and the tumor is removed accordingly. Cited from the article by Kawaguchi et al. (Clin Orthop Relat Res. 2004;419:165-72)9) with original copyright holder's permission.

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  Figure 3 Case 1. (A) A 27-year-old female who underwent planned excision. (A) Preoperative plain radiograph. (B) Coronal, saggital, axial view of the magnetic resonance imaging taken before a planned surgical treatment. (C) Gross clinical photograph of the widely excised tumor. (D) Postoperative plain radiograph.

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  Figure 4 Case 2. A 15-year-old female who undedrwent planned excision. (A) Preoperative plain radiograph. (B) Coronal, saggital, axial view of the magnetic resonance imaging taken before a planned surgical treatment. (C) Gross clinical photograph of the widely excised tumor. (D) Postoperative plain radiograph.

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