Radical Resection of Bone Sarcomas

It is a procedure that involves removing a tumor (malignant or benign) of the bone while preserving the surrounding healthy bone and soft tissues and reconstructing the defect (space where tumor was removed) with a tumor prosthesis.

Bone Sarcoma

What is a Radical Resection of a Bone Sarcoma?

Since sarcomas spread microscopically a distance from the main tumor it is usually important to remove a cuff of surrounding normal tissue around the tumor. The more aggressive the tumor (usually more rapidly growing or called high grade) the wider the margin. Technically radical means removing the entire bone and muscle that contains the tumor. The extent of the bone sarcoma is determined on the preoperative MRI. Sarcomas should never be removed piece by piece as it will spread the tumor. Also, they should not be removed with an intralesional procedure that means entering the tumor and scraping it out of the bone. There are a few exceptions to this rule for some low grade and slow growing sarcomas that are less aggressive and have a much lower risk of coming back than the high grade or rapidly dividing bone sarcomas. Most high grade bone sarcomas are treated with chemotherapy before surgery (preoperative or neoadjuvant chemotherapy) and more chemotherapy after surgery (adjuvant chemotherapy). Radiation is rarely used in the treatment of bone sarcomas. Chemotherapy before surgery is aimed at killing the main tumor as well as any microscopic cells that have traveled in the body. It may also make saving the limb easier with the ability to save more normal tissues around the sarcoma. Sometimes there is major shrinkage of the sarcoma depending on the type of sarcoma. Sometimes a bone sarcoma may be determined to be unresectable meaning it needs an amputation. Preoperative chemotherapy may kill the sarcoma and make it resectable; capable of saving the limb instead of amputating it.

What’s involved in the technique?

What you can expect afterwards

After your surgery you may spend a few nights in the hospital depending on the type of surgery. Once discharged from the hospital, you will be recuperating at home. Various pain protocols and nerve blocks are used to minimize pain. Mostly all patients are very comfortable after the surgery. For the first few days you will ice the area and keep it elevated to reduce swelling. You will return to the office 2 weeks after surgery. Once cleared, you may subsequently start physical therapy depending on the extent of your procedure. We usually prescribe specific physical therapy protocols 3 times a week for 12 weeks after surgery to gradually strengthen muscles. Strengthening with significant resistance after sufficient range of motion is achieved as determined by Dr. Wittig. There may be an ultimate weight limit imposed upon you depending on various factors.  

You will be monitored periodically with X-Ray and MRI imaging over the course of 5 years to ensure there are no signs of recurrence. You will have follow up appointments every 4 months for the first 2 years, then every 6 months for the next 2 years, and then once a year. Since the integrity of the limb has been restored to full or almost full, recovery is anticipated provided the patient adheres to strict physical therapy.

Types Of Physical Therapy

Bone Sarcoma Removal Video

Dr. James Wittig narrates a video illustrating the surgical technique for the resection of a bone sarcoma. | WATCH VIDEO