Surgeries done to save limbs affected by cancer are limb salvage surgeries. There are usually 2 types of cancers (sarcoma), which can affect the limbs.
- Soft tissue Sarcomas.
- Bone sarcomas.
In 1970 and 80s most of these these cancer of the limbs were treated with Amputation( Removal of the affected limb)
Nowadays, Limb Salvage Surgery is the Gold Standard for patients affected by Sarcomas of extremities.
Limb Salvage Surgeries in soft tissue Sarcomas
Large Sarcomas occurring the soft tissue (muscles tendons etc.,) of limbs can affect the adjacent nerves (or) blood vessels (or) bones leading to inactivity of the limbs.
Removal of these tumors needs proper planning and a multimodal approach to save the life and limbs of these patients.
The biopsy has to planned and executed by doctors trained in treating these points. Sometimes a wrongly placed biopsy (or) unplanned excision (whoop’s surgery) can Jeopardize Limb Salvage leading to Amputation.
Any soft tissue mass more than 4-5 cms needs a biopsy before excision.
- Resection of these tumors has to be done with adequate margins all around the lesion (usually 1-2 cm)
- This has to be followed by Radiotherapy and/or chemotherapy based on histology grade, size, location, etc.,
- This needs a “Multidisciplinary team” discussion to optimize the treatment to achieve “Limb Salvage” and “Cure”.
Limb salvage in bone sarcomas
Bone sarcomas usually occur at a younger age. The common tumors are
- Ewing family of tumors – usually occurs in 5-15 years age group.
- Osteosarcoma – most common bone tumor in children – usually occur in 10-20 years age group
- Giant Cell Tumor – most common in 20-30 years age group.
- Chordoma sarcoma – usually occur in elders 50- 70 years age group.
Management of these tumors need proper planning to achieve the goal of limb Salvage to cure. The planning should start right from the time of biopsy to rehabilitation. This need a “Team Approach” with specialists experienced in Sarcoma care.
Biopsy is the most important part of treatment. A wrongly performed biopsy can Jeopardize the chance of Limb Salvage to cure.
Once diagnosis is made these patients need staging workup with CT chest and bone scan or a PET CT scan.
Depending on the stage and diagnosis these patients need intial 3 to 4 cycles of chemotherapy and then reassesed for Surgery .
Chondrosarcoma s does not respond well to chemotherapy . So these patient will be directly subjected to surgery.
Since most of these tumours occur in the limbs , the surgery for these cancer are termed LIMB SALVAGE SURGERIES ( preservation of limbs)
Limb salvage surgeries for bone sarcomas involve two parts.
- Resection – Removal of the bone tumor along with adequate margin of normal tissue around.
- Reconstruction of the bone/soft tissue defect.
Reconstruction:
Reconstruction of the removed part of bone can be done with multiple options available. It has to be chosen depending on various factors like, age of the patient, location of the lesion, availability of resources, extent of disease and treatment required etc.,
Option of reconstruction can be
- Prosthetic reconstruction using
- Custom made prosthetic reconstruction
- Modular prosthetic reconstruction
- 3rd printed prosthetic reconstruction
- Biological reconstructions
- Autograft reconstruction
- Allograft reconstruction
- Recycled tumor bone reconstruction.
