How do you determine if a tumor is resectable and if limb sparing surgery can be performed?

Tumors are resectable and amenable to limb sparing surgery as long as they do not encase the neurovascular structures. In some situations the blood vessels and nerves can be removed with the tumor and reconstructed as opposed to an amputation. Other things that may make a limb sparing surgery impossible include: inappropriately performed biopsies that contaminate important tissues or neurovascular structures; infected tumors; fungating bleeding and infected tumors; limb sparing resections that would remove so much tissue that the extremity will not function; recurrent sarcomas especially those in heavily irradiated tissues; resection of bone sarcoma in the lower extremities that will result in major limb length differences; a pathological fracture through a bone sarcoma spreads the cells a far distance and is often a relative contraindication for a limb sparing surgery. The number 1 cause of a patient requiring an amputation is an inappropriately performed biopsy. Biopsies of musculoskeletal tumors should be performed by the orthopedic oncologist who will ultimately perform the surgery or under the orthopedic oncologist’s direction. Pathological fractures are relative contraindications to limb sparing surgery. With certain bone sarcomas the extremity can be immobilized and chemotherapy given. If the patient has a good response to the chemotherapy as indicated by the fracture healing, limb sparing surgery can be performed. There may be a higher risk of local recurrence in the arm or leg but the overall survival is not compromised in this situation.