Outcomes Of A Limb Sparing Approach To Pediatric Bone Tumors With Blood Vessel Involvement
Malachi Sheahan1, Joyce Kim1, Marie Unruh1, Bruce Torrance1, Robert Batson1, Larry H Hollier1, Claudie Sheahan2
1Louisiana State University School of Medicine, New Orleans, LA;2Louisiana State University School of Medicine, new orleans, LA
INTRODUCTION: Pediatric bone tumors often involve major blood vessels, but the role of vascular surgeons in their management is not defined in the existing medical literature. The aim of this study was to review the outcomes of a multidisciplinary approach to the resection of pediatric osteosarcomas (OS) and osteochondromas (OC) over a 14-year period.METHODS: A retrospective review was conducted of all pediatric bone tumor resections performed with the assistance of vascular surgery at our institution between January 2006 and January 2021. Inclusion criteria for the study included the presence of a vascular surgeon at the operative resection and radiographic evidence of major blood vessel involvement.RESULTS: A total of 105 cases were identified which included 54 benign tumors (47 OC, 7 inclusion bone cysts) and 51 malignant tumors (all OS). Average age was 11.3 years (range 4- 24) and 60% were female (63/105). Average operative blood loss was 226 cc (range 50-550) in the malignant group and 74 (range 50-283) in the benign group (P<.01). Blood vessel reconstruction was performed in 9.8% (5/51) of the malignant cases and 1.9% (1/54) of the benign (P<.01). A tibial artery was ligated without reconstruction in 7.8% (4/51) of the malignant cases. Despite this vessel sparing approach, microscopic margins were clear in all cases. Limb salvage was 100% in both groups throughout the 63-month average follow-up period. Local recurrence occurred in one patient in the malignant group at 61 months which was treated with a second resection.CONCLUSIONS: The ideal management of pediatric bone tumors with major blood vessel involvement remains poorly defined. Our results demonstrate that even in the setting of radiographic evidence of vessel involvement, a multidisciplinary team of vascular and orthopedic surgeons can employ a vessel sparing approach with minimal blood loss, excellent limb salvage, and minimal local recurrence.
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