Limb-Sparing Surgery for Children with Cancer

Limb-sparing procedures are a growing option for children with malignant tumors of the extremities, doctors have found at The Children's Hospital of Philadelphia (PA, USA). One contributing factor is magnetic resonance imaging (MRI), which improves the surgeon's ability to visualize and access tumors preoperatively. Improved chemotherapy is another contributing factor. The newer drugs shrink tumors so more tissue, bone, and muscle can be spared and better mobility can be restored. Studies show that patients treated with limb-sparing surgery have no survival disadvantage compared to those treated with amputation as long as surgery involves removing the entire tumor with wide margins.

A recent case at The Children's Hospital involved a 10-year-old boy with a pelvic tumor dangerously close to his hip joint, spinal cord, and bladder. Thirteen weeks of chemotherapy were needed before the tumor could be removed. In a pioneering operation called an interval hemipelvectomy with A-frame free vascular fibula reconstruction, a surgical team removed the tumor as well as a surrounding cuff of normal pelvic tissue. They then rebuilt the patient's pelvic, using the fibula bone from his leg and the blood vessels attached to it. After healing, the boy was able to resume normal activities.

Once a surgeon removes the cancerous bone or soft tissue tumor, replacement options include an allograft of bone obtained from a patient or cadaver, an endoprosthesis that can be implanted inside the limb, an allograft-prosthetic composite, and vascularized autograft reconstruction (rebuilding the damaged bone and attached blood vessels). Deciding which option is best depends on the location of the tumor, the size of the tumor, and whether it has spread to other areas of the body such as other bones or the lungs.

Today, 85% of kids diagnosed annually with bone and soft tissue cancer are cured, up to 90% without limb loss, according to Dr. John P. Dormans, chief of the hospital's division of orthopedic surgery. "A little more than two decades ago, 85% of children and teens lost their lives. Limb removal was the standard treatment,” he noted.




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Children's Hospital of Philadelphia