Intraosseous resection of bone tumors: our experience

Abstract

Introduction. The effectiveness of efficient surgical interventions in patients with benign, borderline, and malignant bone tumors remains an important topic because such operations imply lower injury rate and volume of surgical intervention while being more physiological. In terms of radicality and consequently recurrence rates they are comparable to more traumatic surgeries such as segmental resections with various types of reconstructions (arthrodesis, endoprosthesis, auto- and allotransplantation using bone fragments, et al) and amputation.Aim. To analyze the results of intraosseous resection for benign, malignant, giant cell, and metastatic bone tumors.Materials and methods. Between 2015 and 2023, 45 interventions of intraosseous resection were performed in 44 patients: 19 (43 %) had enchondroma, 6 (14 %) – giant cell tumor, 4 (9 %) – fibrous dysplasia, 3 (7 %) – solitary bone cyst, 3 (7 %) – aneurysmal bone cyst, 2 (5 %) – chondromyxoid fibroma, 4 (9 %) – metastatic bone lesions, 1 (2 %) – osteoid osteoma, 1 (2 %) – benign fibrous histiocytoma, 1 (2 %) – chondrosarcoma G1 . Among them, 27 interventions were performed in combination with adjuvants (liquid nitrogen cryoablation, argon plasma coagulation, hydrogen peroxide, ethanol). In 24 patients, reconstruction was performed using lyophilized corpse bones, in 5 using autotransplant (fragments of the iliac crest), in 10 using plastic material (in 6 – polymethacrylate, in 4 – osseointegrative material “Rekost”), in 6 using xenoplastic material “Silorif.” Additionally, 16 surgeries were augmented with osteosynthesis (14 extramedullary and 3 intramedullary osteosyntheses).Results. Complications in the early postoperative period were observed in 3 (7 %) patients, in the late postoperative period in 2 (5 %) patients. At follow ups (between 2 and 97 months), 42 (95 %) patients did not have signs of recurrence. Musculoskeletal Tumor Society Score (MSTS) at these follow ups in recurrence-free patients was excellent (mean score – 93.6 %) and good (mean score – 77 %). Eastern Cooperative Oncology Group (ECOG) performance status also showed high functional potential of intraosseous resection: its mean value was 0.3.Conclusion. Use of intraosseous resection including augmentation with adjuvant measures, allowed to achieve excellent functional results in 42 (95 %) of patients with mean follow-up duration of 39.8 months. Fractures in 2 patients demonstrate the necessity of extramedullary osteosynthesis in surgeries on long bones experiencing high load irrespective of the volume of intervention. The obtained results show applicability and high effectiveness of intraosseous resection. For certain indications, it can be the treatment of choice.