Definition & Overview
Radical resection of bone tumours is the surgical method of treating malignant bone growth by removing a large section of the affected bone tissue, with the goal of preserving as much healthy tissue as possible.
A tumour usually forms when there is an abnormal growth of tissue within or on the surface of the bone, resulting in a lump or mass. This abnormal growth can also occur in the bone marrow or the centre of the bone. This condition can develop in almost any part of the body and affects all groups. Though most instances of bone tumours are benign or noncancerous, the condition can still affect the strength and rigidity of the bone. These tumours can make an individual prone to fractures and other skeletal injuries.
Malignant cases of bone tumour are classified as either primary or secondary. The former originates from the bone itself while the latter is a result of cancer metastasis from other parts of the body.
Who Should Undergo and Expected Results
Patients diagnosed with the following conditions can undergo the procedure:
- Benign bone tumours - An example is giant cell tumour, a rare but aggressive condition that typically affects adults.
- Aneurysmal bone cyst – This condition is also quite aggressive and affects growth plates.
- Osteosarcoma or osteogenic sarcoma - Children and teenagers suffering from osteosarcoma or osteogenic sarcoma, which typically occurs in the shoulder, hip, or knee, can benefit from this procedure to stem cancer growth.
- Chondrosarcoma - Adults and middle-aged people can develop this condition, in which malignant growth can be found in the hips, shoulders, or pelvic area. In such cases, resection surgery can be performed to help stop the spread of cancer.
- Ewing sarcoma - This condition is considered a family of tumours that starts in bone cavities and can spread to soft tissues of the body. It is also a rapidly growing cancer affecting the pelvis, upper arms, ribs, backbone, and even the skull.
People with benign bone tumours usually consider resection as the last resort and if the tumour is causing extreme pain and discomfort. It is also considered as means to reduce the risk of fracturing the bone and causing disability. Resection is usually successful in removing any adverse symptoms caused by a bone condition. Patients have to undergo extensive rest period followed by intensive physical therapy to help them regain mobility of affected parts. In some cases, this procedure may also entail bone graft or other prosthetic implants.
The success of radical bone resection to treat malignant tumours depends on the stage of cancer being treated and whether or not it has spread to other parts of the body. In most cases, the patient is asked to undergo other treatment modalities, like radiation therapy or chemotherapy.
How is the Procedure Performed?
Radical resection of bone tumour is considered a major surgical procedure, performed in a hospital setting under general anaesthesia.
The surgeon makes an incision and the location of the bone tumour is accessed. If the tumour is located in the arm or leg, the procedure is termed a limb-salvage surgery, in which the goal is to preserve as much limb function as possible. A wide excision is done to remove the tumour without damaging the nearby nerves, blood vessels, and tendons. The tumour is removed using a specialised bone saw or drill, depending on the extent of tissue to be removed. The surgeon may remove a margin of healthy cells surrounding the tumour to help prevent recurrence. The surgical area is irrigated with saline solution to remove bone debris. After the tumour is removed, the surgeon may place prostheses or implant to fill the gap or hole left by the procedure. A bone graft can also be placed.
The incision is then closed with sutures. The surgeon sends the excised tissue to a pathology lab for further evaluation.
Possible Risks and Complications
- Infection, a risk that is present during and after the procedure
- Excessive bleeding during surgery
- Infection due to implanted prosthesis, which typically necessitates further medical attention
- Skin necrosis or death
- Increased risk of fracture despite surgery
Instability and weakness for an extended period of time if the resection is done close to a joint
Hornicek FJ. Bone sarcoma: Preoperative evaluation, histologic classifications and principles of surgical management. http://www.uptodate.com/home.
Ness KK, et al. A comparison of function after limb salvage with non-invasive expandable or modular prostheses in children. European Journal of Cancer.