Evaluation of Patients Undergoing Limb Salvage Surgery for Bone Sarcomas of the Lower Limb

Abstract Limb salvage surgery (LSS) has been the cornerstone of surgical treatment for bone sarcomas for several decades. Advances in oncological treatments, including neoadjuvant and adjuvant chemotherapy, have facilitated a shift from amputation to LSS. However, the decision to pursue LSS involves careful consideration of associated risks and complications. This study aimed to retrospectively evaluate a cohort of patients (n = 59) who underwent LSS for the resection of bone sarcomas in the lower limb, followed by reconstruction with a tumour endoprosthesis. These procedures were performed at a single institution by multiple surgeons. The collected data was analysed in order to identify potential risk factors associated with both patient survival and endoprosthesis longevity. Several variables, that significantly increased mortality risk, were identified within the patient cohort using multivariate regression analysis. Older patients (above 61) had a 9.74-fold increased risk of death, suggesting age is a major risk factor. Patients with pathological fractures had a 7.83 times higher risk of death, which is a strong predictor. All of these variable findings were statistically significant. Additionally, we characterized the risks and failure modes of tumour endoprostheses within this cohort. We have found different types of failure modes associated with each other. We also looked into patient survival according to the Enneking classification of bone tumour staging. In our cohort, patient distribution across Enneking stages showed a predominance of advanced tumours. The Kaplan–Meier survival analysis demonstrated a clear decline in overall survival with increasing stage. Overall, these findings underline both the predominance of high-grade disease at diagnosis in this series and a strong correlation between higher Enneking stage and diminished long-term survival.