Xiaodong Tang

Peking University People's Hospital, Peping, Beijing, China

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Publications (23)41.37 Total impact

  • Xiaodong Tang, Wei Guo, Rongli Yang, Yifei Wang
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    ABSTRACT: Malignant tumors in proximal tibia invading fibula usually have a large tumor volume and are adjacent to the neurovascular bundles. The prognoses and functional outcomes of limb salvage for these patients are uncertain. We, therefore, asked whether patients with limb salvage surgery for malignant tumors in proximal tibia invading fibula had poorer oncological prognosis, higher complication rate, and lower postoperative functional score compared with patients without fibula invasion. We retrospectively reviewed 129 patients with primary malignant tumors in proximal tibia. The patients were divided into two groups, i.e., with and without proximal fibula invasion. A total of 35 and 94 patients were in the group with and without fibula invasion, respectively. Data on demography, operation time, blood loss volume, complications, survival time, and postoperative function were compared between two groups. The patients with fibula invasion had a longer mean operative time (p = 0.011), less percentage of obtaining wide surgical margin (p = 0.027), lower estimated 5-year survival rate (p = 0.05), higher tumor local recurrence rate (p = 0.042), and earlier postoperative complications (p = 0.01) than the patients without fibula invasion. The difference in postoperative functions as evaluated by the Musculoskeletal Tumor Society functional scoring system was not significant (p = 0.233). Patients with limb salvage surgery for malignant tumors in proximal tibia invading fibula had poorer oncological prognosis, higher complication rate, and acceptable postoperative functions compared with patients without fibula invasion.
    Archives of Orthopaedic and Trauma Surgery 01/2014; · 1.36 Impact Factor
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    ABSTRACT: This study aimed to evaluate the oncologic and functional outcome of the cases treated with hemisacrectomy through a sagittal plane in the sacrum and simultaneous en bloc resection together with the ipsilateral sacroiliac joint without sacrificing the contralateral sacral nerves and summarize tumor resection techniques and reconstruction strategy. En bloc resection of a sacral malignancy with ipsilateral sacroiliac joint and preservation of the contralateral sacral nerves by sagittal hemisacrectomy had been performed in 15 patients. An intra-abdominal aortic balloon was used in all these cases and a combined posterior-anterior approach was adopted. A modified Galveston technique was used to reestablish spinopelvic stability and a nonvascularized fibula autograft was used in selected cases. Contralateral sacral nerves were preserved in all 15 patients. Adequate margins (wide and marginal margin) were accomplished in 10 patients. Local recurrence occurred in seven (47 %) patients, and four of these had an inadequate margin. There was no perioperative death. Four (27 %) patients had wound problems. No mechanical breakdown occurred until the last follow-up. All the patients were able to walk without the use of a walking aid. Sphincter function was partially preserved in all these patients. At the last follow-up, seven (47 %) patients survived without evidence of disease, two (13 %) patients lived with disease, and six (40 %) patients had died of disease. This procedure has an oncologic outcome that is similar to that of other high sacrectomy and a much better function outcome. Although demanding, it is indicated in selected patients.
    European Spine Journal 12/2013; · 2.47 Impact Factor
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    ABSTRACT: PURPOSE: The aim of this article is to summarize our experience in treating sacral wound complications after sacrectomy. We focus, in particular, on factors associated with wound complications, including surgical site infection (SSI) and wound dehiscence. METHODS: The definition of SSI devised by Horgan et al. was applied. Wound dehiscence was defined as a wound showing breakdown in the absence of clinical signs meeting the diagnostic standard for SSI. Between September 1997 and August 2009, 387 patients with a sacral tumor underwent sacrectomy performed by the same team of surgeons and were followed up for ≥12 months. Potential risk factors were evaluated for univariate associations with SSI and wound complications. Multivariable conditional logistic regression was used to identify the combined effects of several risk factors. RESULTS: Of the 387 wounds studied, 274 healed uneventfully, and 113 (29.2 %) broke down because of infection or dehiscence. Fifty-one (13.2 %) patients developed a postoperative SSI, and 62 (16.0 %) patients developed wound dehiscence. Gram-negative bacteria grew in 45 cultures (91.8 %) and included 38 cases of Escherichia coli. Previous radiation, rectum rupture, longer duration of surgery, and cerebrospinal fluid leakage were significantly associated with increased likelihood of developing an SSI. Previous radiation, rectum rupture, age <40 years, history of diabetes mellitus, maximum tumor diameter ≥10 cm, and instrumentation used were risk factors for wound complications. CONCLUSIONS: The incidence of wound complications is not so high at a musculoskeletal tumor center with surgeons experienced in treating sacral tumors. Controlling for these risk factors when possible may improve clinical outcomes.
    European Spine Journal 04/2013; · 2.47 Impact Factor
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    Tao Ji, Xiaodong Tang, Wei Guo
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    ABSTRACT: The aims of this study were to analyze the preliminary clinical outcome of limb salvage using Ligament Advanced Reinforcement System (LARS). It is hypothesized that LARS ligament is a safe and effective choice to enhance prosthetic reconstructions, providing good muscles reattachment and improving joint stability. From March 2009 to March 2010, 7 patients received megaprosthesis reconstruction following tumor resection in combination with soft tissue reconstruction using LARS. Reconstructions were four around the knee and three in proximal femur. The average MSTS 93 score was 81.0% at a mean follow-up of 27.0 months. No infection was observed. The results show that LARS appears to be an effective device for limb salvage surgery providing good muscles reattachment, improving joint stability.
    The Journal of arthroplasty 03/2013; · 1.79 Impact Factor
  • Wei Guo, Xiaodong Tang, Jie Zang, Tao Ji
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    ABSTRACT: Study Design. Nine patients with malignant sacral tumor underwent one-stage total sacrectomy. The oncological and functional results are analyzed.Objective. To describe the surgical technique and evaluate the clinical outcome of the surgery.Summary of Background Data. Very few reports specifically address total sacrectomy, and the two-stage procedure combining the anterior and posterior approach is the most common method used for treatment.Methods. Between July 2007 to July 2010, 9 patients (7 men, 2 women; mean age 33 years, range 13-59 years) with malignant sacral tumor underwent one-stage total sacrectomy the Peking University People's Hospital. The pathologic diagnosis was chordoma in 3 patients, osteosarcoma in 2, chondrosarcoma in 2, malignant schwannoma in 1, and Ewing's sarcoma in 1.Results. Oncologic results: All 9 patients were followed up for 11 to 35 months (mean follow-up time 19.7 months). Local recurrence was detected in the right ilium in the patient with Ewing's sarcoma at 7 months after surgery, and locally in another patient with osteosarcoma at 3 months after surgery. The recurrent lesion in the right ilium was widely resected in the patient with Ewing's sarcoma and no new lesion was found at the last follow-up, but this patient died of the lung metastases finally. The local recurrent lesion in the patient with osteosarcoma was treated with adjuvant chemotherapy and local radiation. Functional result: The S1 nerve root was cut bilaterally in 8 patients during surgery, resulting in the loss of foot plantar flexion. The 5 lumbar vertebrae were also resected with the sacrum in one patient, but the bilateral L5 nerve roots were preserved, so dorsiflexion was maintained in this patient.Conclusion. Total sacrectomy can be performed successfully using a one-stage combined anterior and posterior approach and is an important procedure for the treatment of primary malignant tumor involving the top portion of or the whole sacrum.
    Spine 02/2013; · 2.16 Impact Factor
  • Wei Guo, Xin Sun, Tao Ji, Xiaodong Tang
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    ABSTRACT: Surgical treatment of pelvic osteosarcoma is often challenging. The objective of this study was to assess the oncologic and functional outcome and the operation-related complications of patients with pelvic osteosarcoma who were treated in a single center in the past decade. Nineteen patients underwent surgical procedures between June 2000 and June 2009. There were 11 males and 8 females with a mean age of 30 years. According to Enneking and Dunham pelvic classification system, there were: Type I-3, Type I + IV-3, Type I + II-2, Type II + III-4, Type I + II+ III-1, Type III-1, and type I + II+ IV-5. All patients received chemotherapy. Local recurrence rate was 26.3% (5/19). The 5-year overall survival rate was 44.9%. Seventeen patients received reconstruction after tumor resection. The average MSTS 93 score was 18 (10-23) for the 11 patients with hemipelvic endoprosthetic reconstruction and 23 (20-25) for 6 patients with rod-screw reconstruction. Complication was found in 7 of 19 patients (36.8%). The oncological results of pelvic osteosarcoma are poor at best. Even with a higher complication rate, we believe restoration of pelvic ring continuity and hip joint mobility is reasonable option to achieve favorable functional outcomes in selected patients.
    Journal of Surgical Oncology 02/2012; 106(4):406-10. · 2.64 Impact Factor
  • Tao Ji, Wei Guo, Rongli Yang, Xiaodong Tang
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    ABSTRACT: To evaluate the outcome of two-stage revision for prostheses infection in patients with bone tumor after knee prosthetic replacement. Between August 2003 and August 2010, 22 patients with prostheses infection, who underwent knee prosthetic replacement in limb salvage treatment because of bone tumor, received two-stage revision. There were 11 males and 11 females with an average age of 29.6 years (range, 15-55 years). Prosthetic infection occurred after primary replacement in 20 patients and after revision surgery in 2 patients from 15 days to 89 months after operation. According to Coventry and Fitzgerald classification, type I was found in 3 cases, type II in 15 cases, and type III in 4 cases. The time from infection to admission was 5-47 months (mean, 10.2 months). The results of bacterial culture were positive in 9 cases and negative in 13 cases. Two patients had fever and leukocytosis. In one-stage, the implants and infected tissue were removed, and an antibiotic cement spacer with an intramedullary nail was implanted. In two-stage, a new endoprosthesis was inserted after infection was controlled. The C-reactive protein and erythrocyte sedimentation rate before one-stage debridement were significantly higher than those before two-stage revision (P < 0.05). All patients were followed up 5-63 months (mean, 23.6 months). Infection was controlled after one-stage debridement in 18 cases (81.8%); two-stage revision was performed in 17 cases, and 1 case refused to receive two-stage revision. Of 17 patients, 1 patient was amputated because of infection at 5 months after revision. Four patients (18.2%) underwent amputation because of failure to control infection after one-stage debridement. The limb salvage rate was 77.3% (17/22). One case of renal cell carcinoma with bone metastasis died of original disease after 1 year and 6 months of operation. The Musculoskeletal Tumor Society (MSTS 93) score was 69.4 +/- 12.7 at last follow-up. Two-stage revision should be performed in time and it has good results in the treatment of prostheses infection in patients with bone sarcomas after knee prosthetic replacement.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 01/2012; 26(1):21-5.
  • Dasen Li, Wei Guo, Rongli Yang, Xiaodong Tang, Huayi Qu
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    ABSTRACT: To evaluate the surgical procedure of reinforced acetabular cage with caudal flange in reconstruction of pelvic defect after acetabular tumor resection. Between June 2003 and December 2009, 25 patients with Harrington class III pelvic defect underwent reconstruction with a reinforced acetabular cage with caudal flange and total hip arthroplasty (THA). There were 13 males and 12 females with an average age of 51.2 years (range, 13-73 years). The main clinical manifestations included hip pain and buttock pain, with a median disease duration of 6 months (range, 1-96 months). Pathological findings showed 18 cases of metastasis, 3 cases of multiple myeloma, 1 case of non-Hodgkin's lymphoma, 1 case of grade I chondrosarcoma, 1 case of giant cell tumor, and 1 case of chondroblastoma. For the patient with chondroblastoma, THA with LINK RIBBED system was used. An artificial total hip system made in China was used in 6 patients and LINK SP II system was used in the other 18 patients. No patients died perioperatively. Deep infection and hip dislocations occurred in 1 and 2 patients, respectively. At last follow-up, 8 of 18 patients with metastasis died of cancer and the average survival time was 11 months. The other 10 who were alive were followed up 15 months on average. One patient with multiple myeloma died of pulmonary infection at 21 months after operation and the other 2 with multiple myeloma and 1 with lymphoma were alive with an average follow-up of 17 months. The patient with grade I chondrosarcoma and patient with chondroblastoma were followed up 58 and 12 months, respectively, without recurrence. Recurrence occurred in the patient with giant cell tumor at 19 months after operation. Loosening of implant occurred in 3 patients because of local tumor recurrence. For the 23 patients at 6 months after operation, the mean Musculoskeletal Tumor Society (MSTS) 93 score was 81% (range, 57%-93%). Reinforced acetabular cage with caudal flange could be used together with THA for reconstruction of Harrington class III pelvic defects after acetabular tumor resection, and low incidence of postoperative complication and good functional outcome could be expected.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 12/2011; 25(12):1409-13.
  • Xiaodong Tang, Wei Guo, Tao Ji
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    ABSTRACT: The outcomes of patients with solitary metastasis around the acetabulum who received en bloc resection and reconstruction are unclear. The purpose is to evaluate the oncologic results, complications, and functional outcomes in these patients. Fifteen patients who underwent periacetabular resection and modular endoprosthetic reconstruction were reviewed retrospectively. Eleven patients were alive and four had died of their respective diseases. The mean follow-up time for the living patients and the non-surviving patients was 32 and 11 months, respectively. One of the three patients presented with local recurrence received hindquarter amputation. Five patients with superficial wound problem were treated with debridement and were healed eventually. Two patients who had hip dislocation received closed reduction. Pain was relieved in most patients, and ten patients were able to walk outside their house. The average MSTS 93 score was 20.9 of a total of 30 points (69.7%). When evaluated according to the modified Allan scoring system, postoperative scores on pain, independence, and mobility had significant improvement. En bloc tumor resection and reconstruction with modular hemipelvic prosthesis in patients who had a solitary periacetabular metastasis can provide long-term survive, tumor local control, low complication rate, and good functional recovery.
    Archives of Orthopaedic and Trauma Surgery 09/2011; 131(12):1609-15. · 1.36 Impact Factor
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    Dasen Li, Wei Guo, Xiaodong Tang, Tao Ji, Yidan Zhang
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    ABSTRACT: The purpose of the study was to develop a surgical classification system for primary malignant sacral tumors. The sacrum is divided into three regions 1, 2 and 3 by the S1-S2 and S2-S3 junctions. En bloc resections were classified into five types: type I involves regions 1, or 1 and 2, or regions 1, 2 and 3, type II involves regions 2 and 3, and type III involves only region 3. Type IV includes sagittal hemisacrectomy and resection of a portion of the adjacent ilium. Type V includes the sacrum and the fifth lumbar vertebra. 117 patient cases (68 females and 49 males) were reviewed. There were two perioperative deaths. Of the 35 patients who should have undergone type I resection, local recurrence (LR) occurred in four of the 14 patients who underwent type I resection with free margins without tumor rupture. The other 21 patients underwent piecemeal resection, and LR occurred in 15 (P = 0.013). 35 patients underwent type II resection. Free margin without tumor rupture was accomplished in 26 and LR occurred in 6. Tumor rupture (TR) occurred in the other 9 and LR occurred in seven (Yates' P = 0.012). All 33 patients underwent type III resection with free margins without tumor rupture. LR occurred in five. 11 patients had type IV resection. Free margin without tumor rupture was accomplished in seven and LR occurred in three. TR occurred in the other four, and LR occurred in two (Yates' P = 0.689). One patient underwent type V resection with free margin without tumor rupture and LR occurred. Postoperatively, less than 1/3 needed long-term urethral catheterization. No patients received colostomy for postoperative fecal incontinence. All the patients were able to ambulate. Our classification system and the corresponding surgical approaches are helpful in dealing with primary malignant sacral tumors. Better oncologic results could be expected if free margin without tumor rupture was accomplished.
    European Spine Journal 06/2011; 20(12):2275-81. · 2.47 Impact Factor
  • Xiaodong Tang, Wei Guo, Rongli Yang, Tao Ji, Xin Sun
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    ABSTRACT: Scapular prosthetic replacement after total scapulectomy can result in oncologic salvage and good postoperative function with a low rate of complications. Ten patients who underwent constrained scapular prosthetic replacement after total scapulectomy between 2003 and 2009 were reviewed retrospectively. At a mean follow-up of 36 months, 2 patients died of their disease. One patient showed recurrence and metastasis. Complications, including dislocation and superficial wound infection, occurred in 2 patients. The mean Musculoskeletal Tumor Society 93 score was 23.2 of 30 points. High scores were achieved for most items except hand position; only 5 patients can raise their hands above their waist. The ranges of active shoulder abduction and forward flexion motion were 20° to 45° and 40° to 65°, respectively. All patients retained normal hand and elbow functions. Although there are limitations in the shoulder's active motion, reconstruction with a scapular prosthesis can provide oncologic salvage and result in good postoperative function with a low rate of complications.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 04/2011; 20(7):1163-9. · 1.93 Impact Factor
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    ABSTRACT: Chondrosarcoma represents the second most common primary malignant bone tumor causing significant morbidity due to local recurrence and limited treatment options. Conventional cytotoxic chemotherapy has been proven to be largely ineffective to this sarcoma. Here we report that sorafenib is effective in growth inhibition of chondrosarcoma cell lines in vitro. Chondrosarcoma cell lines (SW1353 and CRL7891) were treated with sorafenib. Flow cytometry, DAPI assay, and Western blotting were employed to determine the effects of sorafenib in inhibitory proliferation and induce apoptosis in chondrosarcoma cells in vitro. The results showed that sorafenib effectively inhibited cell growth and induced apoptosis in chondrosarcoma cells, which was concurrent with inhibition of the expression of phospho-MEK and phospho-ERK. Further more the expression levels of cyclin D1, Rb and anti-apoptotic proteins Bcl-xl and Mcl-1 significantly reduced, but no changes in Bcl-2 and Bax. We although detected the expression of Akt, JNK, p38 and their respective phosphoprotein, but did not found meaningful changes. Our findings demonstrate that sorafenib inhibited the Ras/Raf/MAPK pathway in a time- and dose-dependent fashion in chondrosarcoma cell lines SW1353 and CRL7891 and suggest that sorafenib may be a new therapeutic option for patients with chondrosarcoma.
    Journal of Surgical Oncology 12/2010; 102(7):821-6. · 2.64 Impact Factor
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    ABSTRACT: Dedifferentiated chondrosarcoma (DDCS), a highly malignant variant of chondrosarcoma (CCS), is characterized by high-grade sarcoma adjacent to low-grade chondroid tumor. Owing to its complicated composition, the histogenesis of this tumor remains controversial. Earlier, we carried out DNA microarray analysis using chondrosarcomatous tissues, and found that Sox9 and runt-related transcription factor 2 (Runx2) were differentially expressed in CCS compared with DDCS. Here, we analyzed Sox9, Runx2, Col2a1, and Col1a1 in NDCS-1 (DDCS) and SW1353 (CCS) cell lines using reverse transcriptase-polymerase chain reaction, western blot, and immunocytochemistry. The results showed high expression of Runx2 and Col1a1, and low expression of Sox9 and Col2a1 in NDCS-1 cells. In SW1353 cells, however, gene expressions were reversed. These findings provide evidence that Sox9 and Runx2 are involved in the occurrence and development of DDCS.
    European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 11/2010; 19(6):466-71. · 2.21 Impact Factor
  • Tao Ji, Wei Guo, Rongli Yang, Xiaodong Tang
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    ABSTRACT: To identify the postoperative function and short-term outcome of Global Modular Replacement System (GMRS) for reconstruction of defect after removal of tumor so as to supply information for clinical application. Between March 2007 and May 2009, 30 limb-salvage cases reconstructed with GMRS were retrospectively reviewed, including 18 males and 12 females with a median age of 25 years (range, 11-57 years). The preoperative diagnoses were osteosarcoma in 15 cases, malignant fibro-histiocytoma in 4, giant cell tumor in 3, chondrosarcoma in 2, and Ewing's sarcoma and angiosarcoma in 1 respectively. The duration of symptom ranged from 1 to 15 months with an average of 5.6 months. There were 4 revision cases at mean time of 3.4 years after index surgeries. The locations were the proximal femur in 3 cases, distal femur in 22 cases, and proximal tibia in 5 cases. According to Enneking stage, 2 cases were rated as stage IB, 1 as stage IIA, and 27 as stage IIB. Four cases were complicated by pathologic fracture. The average operation time was 165 minutes (range, 120-240 minutes); the mean blood loss was 448.3 mL (range, 100-1500 mL); and the mean resection length was 14.1 cm (range, 7.5-22.5 cm). All the wounds healed by first intention. All 30 patients were followed up 10-35 months (22.3 months on average). Local recurrence occurred in 2 cases (6.7%) at 5 and 14 months respectively and distal metastasis occurred in 5 cases (16.7%) at 4-12 months (7.3 months on average) postoperatively. One patient died of multiple lung metastases at 10 months postoperatively. Twenty-nine patients survived at last follow-up, including 25 cases of tumor-free survival and 4 cases of tumor bearing survival. Aseptic loosening occurred in 2 cases (6.7%) at 1.5 years and 2 years postoperatively respectively. Deep infection occurred in 1 case (3.3%) at 1 year postoperatively. At last follow-up, the Musculoskeletal Tumor Society (MSTS) 93 scores were 4.6% +/- 0.7% for pain, 3.7% +/- 0.9% for function, 3.2% +/- 1.3% for satisfactory degree, 4.3% +/- 0.9% for orthosis, 3.7% +/- 0.7% for walking, 3.3% +/- 1.0% for gait; total score was 75.9% +/- 14.2%. The Toronto Extremity Salvage Score (TESS) score was 87.0 +/- 7.0. Reconstruction for defect after removal of tumor with GMRS has satisfactory short-term outcome with good function recovery and low complication rate.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 10/2010; 24(10):1192-5.
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    ABSTRACT: Aortic balloon occlusion has been introduced into sacral tumor surgery to reduce extensive hemorrhage. The purposes of this retrospective study were to determine the efficacy of aortic balloon occlusion in decreasing intraoperative and postoperative blood losses and to analyze the complications of this technique. The cases of 215 patients in whom a sacral tumor had been treated surgically between 1997 and 2009 were studied retrospectively. Ninety-five patients who had had sacral tumor resection without aortic balloon occlusion were compared with 120 patients in whom aortic balloon occlusion had been carried out during the tumor resection. The demographic data, possible factors influencing hemorrhage, and total blood loss volume (including intraoperative and postoperative volumes) were determined with a review of the medical records and compared between the two groups. There were no significant differences between the two groups in terms of the demographic data, grade of malignancy, tumor blood supply, location of the tumor, percentage of patients who had a recurrent tumor or preoperative radiation, surgical approach, or type of resection. The patients with aortic balloon occlusion had a larger mean tumor volume, more frequently had a sacral reconstruction, and had a longer mean operative time; however, their mean total (2963 mL) and intraoperative (2236 mL) blood loss volumes were lower than those of the patients without occlusion (4337 and 3935 mL, respectively) (p < 0.001). Complications related to aortic balloon occlusion included femoral artery embolism in three patients and hematoma formation at the puncture site in five. Aortic balloon occlusion decreases the total and intraoperative blood loss volumes in patients treated with sacral tumor surgery who require extensive dissection. There is a low rate of balloon-related complications.
    The Journal of Bone and Joint Surgery 07/2010; 92(8):1747-53. · 3.23 Impact Factor
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    ABSTRACT: To evaluate the surgical skill, cause of revision, complications, prosthetic survival and postoperative function in revision of custom-made tumor prosthesis replacement of knee joint. The clinical data of 33 patients who received prosthetic revision surgery between June 2002 and June 2007 were reviewed. There were 17 males and 16 females with an average age of 33.1 years (range, 16-67 years). The pathological diagnosis included 17 osteosarcomas, 11 giant cell tumors, 2 malignant fibrous histiocytomas, 1 chondrosarcoma, 1 synovial sarcoma, and 1 liposarcoma. The involved locations were distal femur in 22 cases and proximal tibia in 11 cases. The average interval between first prosthetic replacement and revision surgery was 45.3 months (range, 6-180 months). The reason for revision included local recurrence in 2 cases, deep infection in 8 cases, aseptic loosening in 7 cases, periprosthetic fracture in 1 case, prosthetic stem fracture in 6 cases, and prosthetic hinge failure in 9 cases. Six patients with deep infection received two-stage revision surgery, while the other 27 patients received one-stage revision. Cemented prostheses were used in all patients. Allograft prosthetic composite and revisions were used in 2 patients who had deficit of diaphysis for stem fixation. In 17 patients who received both primary prosthetic replacement and revision, the operative time was (149.8 +/- 40.5) minutes and (189.9 +/- 43.8) minutes, and the blood loss was (605.2 +/- 308.0) mL and (834.1 +/- 429.9) mL for primary prosthetic replacement and revision, respectively; all showing statistically significant differences (P < 0.05). The mean time of follow-up was 45.1 months (range, 12-76 months). Healing between allograft and host bone was obtained in 2 patients with allograft prosthetic composite and revision after 1.5 years and 2 years, respectively. After revision surgery, 3 patients died of lung metastasis after 12-24 months, and other 3 patients having lung metastasis were alive with disease. Nine (30%) complications occurred in 30 patients who were alive at last follow-up. The complications included wound infection in 2 patients, deep infection in 5 patients, mechanical problems in 2 patients. Prosthetic failure occurred in 7 patients (23.3%). The 5-year survival rate of revised prosthesis was 68.6%. The Musculoskeletal Tumor Society (MSTS) score at 6 months after revision (73.6% +/- 14.4%) was significantly improved (P < 0.01) when compared with before revision (57.1% +/- 10.6%). The main reasons for revision of custom-made tumor prosthesis of knee joint were mechanical problems and deep infection. Although revision surgery of knee is relatively complicated and has some complications, a functional limb could be maintained in most tumor patients.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 01/2010; 24(1):5-10.
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    Wei Guo, Dasen Li, Xiaodong Tang, Tao Ji
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    ABSTRACT: Surgical treatment of pelvic chondrosarcoma involving acetabulum is challenging. Primary goals of surgical treatment include local control and prevention of distant metastases. A secondary goal is maintenance of quality of life by avoiding major amputative surgery. The purpose of the study was to review the oncological outcome, functional outcome, and the surgical complications of patients with periacetabular chondrosarcomas in the context of resection and reconstruction treated at one tumor center in the past decade. Forty-five cases between June 1998 and June 2007 were retrospectively reviewed. There were 26 men and 19 women with an average age of 41.2 (18-63) years. Patients were followed up for a median time of 37 months (18-119 months). There were 32 patients with conventional chondrosarcomas, 9 with dedifferentiated chondrosarcomas, and 4 with mesenchymal chondrosarcomas. According to Enneking's classification there were: Type II-1, Type I + II-8, Type II + III-23, Type I + II + IV-8, and Type I + II + III-5. Six patients had an external hemipelvectomy, whereas 39 patients underwent a limb-salvage procedure. In 27 patients the defect was reconstructed by a modular hemipelvic endoprosthesis and in 4 patients reconstruction by saddle endoprosthesis. Five patients received reconstruction with devitalized tumor bone and three underwent iliofemoral arthrodesis. The 5-year estimated survival was 62.6%. Local recurrence occurred in 10 (22.2%) patients at an average of 18 months after operations. Ten (22.2%) patients had distant metastasis. The average MSTS 93 score was 68.3% (33.3-100). Eighteen complications occurred in 13 patients (28.9%). Wound complication occurred in six (13.3%) patients. Deep infection rate was 11.1%. Favorable oncological and functional outcome can be achieved in selected patients with periacetabular chondrosarcomas. The complication rates were still high; however, facing the goal of limb salvage, a certain number of complications is acceptable.
    Journal of Surgical Oncology 12/2009; 101(2):160-5. · 2.64 Impact Factor
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    Xiaodong Tang, Wei Guo, Rongli Yang, Shun Tang, Yi Yang
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    ABSTRACT: The options for reconstruction after excision of a tumor around the elbow are technically difficult and limited. We retrospectively reviewed 25 patients who underwent custom-made endoprosthetic reconstruction after tumor resection near the elbow between 1998 and 2007. At final follow-up, 14 patients (56%) were alive, and 11 (44%) had died of their disease. Local recurrence was encountered in 4 patients (16%). Complications occurred in 6 patients (24%), including vascular injury, neurapraxia of the radial nerve, and aseptic loosening in 4. The average Musculoskeletal Tumor Society 93 score was 23.9 points, and the average Mayo Elbow Performance score was 82 points. Pain was relieved in all patients, although some limitations of lifting ability were reported. Ten patients had an arc of elbow motion of more than 100 degrees after reconstruction. In most patients, local tumor resection and prosthetic reconstruction of the elbow can be done with oncologic safety, and provides good function with low rates of complications.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 07/2009; 18(5):796-803. · 1.93 Impact Factor
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    Wei Guo, Tao Ji, Xiaodong Tang, Yi Yang
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    ABSTRACT: Retrospective analysis. To estimate the clinical outcome of conservative surgery (intralesional curettage or partial excision) aided by effective intraoperative hemorrhage control in patients with giant cell tumors of the sacrum. Giant cell tumors of the sacrum present a challenging therapeutic problem. Wide resection is associated with higher morbidity and spinal instability. Whether conservative surgery aided by effective intraoperative hemorrhage control can achieve low recurrence rates remains uncertain. The clinical records of 24 patients with an average age of 35 years who had undergone conservative surgery for sacral giant cell tumor between 1996 and 2005 were evaluated retrospectively. The disease onset, tumor size, operation records, complications, follow-up status, and functional outcome were analyzed. The mean duration of follow-up was 58 months (median, 50 months; range: 25-132 months). All the patients had a conservative procedure aided by intraoperative occlusion of the abdominal aorta. The mean estimated blood loss was 3217 mL. The mean length of the operation was 190 minutes. Seven (29.2%) patients developed recurrences. The mean time from the index surgical procedure to the first recurrence was 13 months (range: 8-31 months). The 5-year local recurrence-free survival rate was 69.6%. Seventeen (70.8%) patients retained normal urinary function and 16 (66.7%) patients preserved normal bowel function. No patients had urinary or bowel dysfunction when both S3 nerves were preserved. Ten (41.7%) patients had complications perioperatively or during the follow-up. Seven (29.2%) patients had wound complications. Considering the acceptable local recurrence rate, conservative surgery aided by effective control of intraoperative hemorrhage should be considered as an alternative procedure for patients with giant cell tumors of the sacrum. The advantages include lower morbidity, reduced neurologic deficits, speed and ease of the surgical procedure, reduced blood loss, preservation of spinal and pelvic continuity, and a low recurrence rate.
    Spine 06/2009; 34(10):1025-31. · 2.16 Impact Factor
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    Xiaodong Tang, Wei Guo, Rongli Yang, Shun Tang, Tao Ji
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    ABSTRACT: As a large amount of blood loss is sometimes encountered in limb salvage procedures for pelvic tumours, it is essential to identify risk factors predicting the possibility of extensive haemorrhage. We retrospectively reviewed 137 patients who underwent pelvic tumour resections. Patients with an estimated blood loss greater than 3,000 ml were classified as having a large amount of blood loss. Sixty-one (44.53%) patients had blood loss greater than 3,000 ml. Tumours involving the acetabulum or sacrum, tumour volume greater than 400 cm(3), aorta occlusion, resection method, reconstruction and operative time were all associated with a large amount of blood loss. Pelvic tumours involving the acetabulum or sacrum (odds ratio: 4.837), tumour volume greater than 400 cm(3) (odds ratio: 3.005) and planned operation time of more than 200 min (odds ratio: 3.784) independently predicted a large amount of blood loss. Pelvic tumours with these characteristics were likely to have a large amount of blood loss during surgery.
    International Orthopaedics 01/2009; 33(3):751-6. · 2.32 Impact Factor