Long Term Outcomes Of Patients Undergoing Resection Of Humeral Tumours: A Comparison Of Limb Salvage To Amputation

Abstract

Endoprosthetic reconstruction is performed where applicable for tumours affecting the humerus as patient outcomes are thought to be superior to amputation. Limb salvage allows the patient greater function without compromising the outcome of their treatment.

The aim of this study is to compare the outcomes of patients undergoing surgical management of tumours affecting the humerus, focussing on survival rates, tumour recurrence and the necessity for further resection.

Patients undergoing resection of tumours of the humerus between the dates of 01/01/1994 and 01/01/2009 were included and divided into those undergoing amputation and those undergoing endoprosthetic replacement. Patient age at surgery, histological diagnoses, level of resection, post op survival and tumour recurrence were noted.

173 Patients were included. 98 endoprostheses were implanted, the majority being proximal humeral replacements (68). The patients with both the longest post op survival and highest survival rate at the time of follow-up were those undergoing diaphyseal replacements with a mean post op survival of 1666 days and survival at follow-up of 72.7%. This was also the youngest group with a mean age of 37 years, 3 months. The most common histological diagnosis in the endoprosthesis group was metastatic disease (30) with their commonest primary origin being renal (14). The other major groups were primary osteosarcomas (21) and chondrosarcomas (22). Those treated for metastatic disease had the lowest survival rate at follow-up (3.3%), the greatest survival rate among the major groups being osteosarcoma (66.7%). The latter represented the youngest group of patients, a mean age of 21 years, 2 months. Amputations subsequent to endoprosthetic replacement due to tumour recurrence were required in 9.5% of osteosarcoma patients, the highest rate. Amputations were required in 8-9% of patients undergoing diaphyseal or distal replacement in comparison to the 2.9% for proximal humeral replacements. 75 amputations were included, the largest subgroup being forequarter (37). This subgroup had the longest post op survival (872 days) and the greatest survival rate at followup of 37.8%. It also represented the youngest mean average age of 47 years, 10 months. Rates of tumour recurrence were higher in the forequarter group (37.84%) than the other levels of amputation. Histological diagnoses of those patients undergoing amputation were evenly spread. The largest groups were osteosarcoma (14), chondrosarcoma (9), malignant peripheral nerve sheath tumours (PNST) (7) and malignant fibrous histiosarcoma (7). Osteosarcoma had the highest survival rate at follow-up (64.3%) but also the shortest post op survival (420 days) and the highest tumour recurrence rate post amputation (42.86%). Osteosarcoma represented the youngest patient group (25 years, 1 month) with malignant fibrous histiosarcoma the oldest (68 years, 3 months). The latter also had the lowest survival rate at follow-up. Tumour recurrence rates of those undergoing amputation were higher (32%) than those undergoing endoprosthetic reconstruction (12.2%). The average post op survival of those undergoing amputation was lower as well as the survival rate at follow-up.

The outcomes of patients undergoing endoprosthetic replacement compare favourably to amputation. An expansion of this study focussed on patient centred outcomes is underway with an aim to investigate whether or not limb salvage following humeral tumour resection does indeed result in greater quality of life and function compared to amputation.

Full text

Long Term Outcomes Of Paents Undergoing
Resecon Of Humeral Tumours: A Comparison
Of Limb Salvage To Amputaon
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Introducon
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Endoprostheses
68
11
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Amputaons
37
21
17

Histology Distribuon
Endoprostheses Amputaons
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Results
Reconstrucon Proximal Diaphyseal Distal Total
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Results
Amputaon Forequarter Shoulder
Disarculaon
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Results
Endoprostheses Amputaons
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Results
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Conclusion
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,0!!!B),!(
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C)*,!!,!
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Study Expansion
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.