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Proximal femur sarcomas with intra‐articular disease—Do intra‐articular resections provide adequate local control?
Author(s) -
Nayak Prakash,
Gupta Srinath,
Patil Akshay,
Gulia Ashish,
Puri Ajay
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26182
Subject(s) - medicine , surgery , avascular necrosis , labrum , resection margin , resection , articular surface , femur , articular capsule of the knee joint , sarcoma , hazard ratio , confidence interval , knee joint , femoral head , arthroscopy , pathology
Background and Objectives Hip preserving (intra‐articular) resections for proximal femur sarcoma have better function compared to peri‐acetabular (extra‐articular) resections, which are more complex and morbid. But, do intra‐articular resections in selected cases with intra‐articular disease provide adequate local control? Method Extra‐articular resection or intra‐articular resection in cases without pathologic fracture or away from joint/capsule was classified as a planned safe margin (SM). Circumferential removal of labrum without acetabular resection in cases without gross joint contamination was classified as planned close margins (CM). We analyzed local recurrence‐free survival (LRFS) (death as a competing event) for 86 proximal femur resections (SM = 55, CM = 31). Results The 5 years LRFS was 84% (n = 6/55, 10%) in the SM group and 67% (n = 4/31, 12%) in the CM group. There was no worsening of local recurrence (LR) in the CM group (subdistribution hazard [sH] = 0.69; 95% confidence interval [CI], 0.21‐2.29; P = .56). Poor chemotherapy‐induced necrosis predicted worse LR (sH = 0.1; 95% CI, 0.01‐0.8; P = .03). Overall survival was 16% (SE 8%) at 5 years with LR vs 64% (SE 7%) without LR ( P = .0076). Conclusion In proximal femur sarcomas with potential for involvement of the hip joint, a CM in selected cases did not worsen LR; providing an option for avoiding additional morbidity with extra‐articular resections.