Mid-term complication rate after limb salvage for pediatric bone sarcomas.

Abstract

The purpose of this study is to describe the mid-term complication profile after limb salvage for pediatric bone sarcomas utilizing all reconstruction techniques. A retrospective review was performed on patients less than 18 years who underwent resection of a primary bone sarcoma with limb salvage reconstruction. The primary outcome measure was the all-cause postoperative complication rate. Complications were grouped into major or minor categories. Patients were stratified by reconstruction type (endoprosthetic, allograft, allograft-prosthetic composite, biologic). The timing of complications and reoperations was analyzed. Eighty-four patients were included (median follow-up 46 months). The overall complication rate was 75%, and the major complication rate was 36%. Twenty-five percent had two complications, and 18% had three or more complications. The reoperation rate was 55%, and 14% required three or more reoperations. Seventy-one percent of patients sustained their first complication within 1 year. Twenty-eight percent of patients underwent a reoperation within 12 weeks. Limb salvage for pediatric bone sarcomas is associated with a high rate of complications and reoperations, regardless of reconstruction technique. Despite the substantial complication rate, these procedures are essential to the multidisciplinary care of children with bone sarcomas, as limb salvage is commonly pursued. We hope to provide realistic postoperative expectations and argue that surgeons caring for these patients must be prepared to manage complications, as they tend to arise during the window of adjuvant chemotherapy.