Limb salvage surgery for scapular sarcoma:a review of 19 cases

Objective To investigate functional and oncological results of different limb salvage strategies for scapular sarcoma.Methods A retrospective analysis of 25 patients diagnosed with malignant tumor of the scapula from May 2001 to May 2012 was performed.There were 17 males and 8 females and the mean age was 43 years( range:0.25-73 years).Tumors include 9 metastatic tumors and 16 primary malignant tumors.Nineteen patients received limb salvage surgery( 4 metastatic tumors,15 primary malignant tumors).According to Enneking surgical staging:II B 16 cases,stage III 9 cases.In 4 metastases cases of limb salvage,2 cases received partial resection of the scapula and the scapulohumeral joint was preserved,1 case received humeral head suspension after complete scapula resection,1 case received constrained shoulder prosthesis after complete scapula resection.In 15 primary malignant tumors cases of scapula limb salvage,7 cases received partial resection of the scapula and the glenoid and scapulohumeral joint were preserved,1 case received scapula allogeneic transplantation,1 case received lesion curettage and bone cement filling,1 case received inactivated autologous scapula replantation,3 cases received humeral head suspension after complete scapula resection,2 cases received constrained shoulder prosthesis after complete scapula resection.19 cases were followed up with the mean period of 36 months( range:6-60 months).Results In 6 dead cases,2 cases of scapula metastases in liver tumors and 1 case of scapula metastases in angiosarcoma died of primary tumors metastases and organ failure,1 case with osteosarcoma died of lung metastases,1 case with scapula synovial sarcoma died of local recurrence plus lung metastases,1 case with scapula myeloma died of non primary disease.According to MSTS( 93) scored for the various types of reconstructive surgery.One case of allogeneic scapula got 18 points,1 case of inactivated autologous replantation got 26 points,cases of scapula partial resection and glenoid preservation got 24 points on average,cases of scapula total removal and the humeral head suspension got 21 points on average,cases of constrained shoulder prosthesis after complete scapula resection got 24.7 points on average.Shoulder flexion and extension were in the range of the 90°to 20°.Outreach range was of 40° to 95°.Conclusions Partial scapulectomy with the preservation of glenoid,and total scapulectomy with constrained scapular prosthesis both can preserve the shoulder functions to the greatest degree.Inactivated autologous replantation can be regarded as an alternative for preschool children with scapula malignant tumors.Prosthesis,autologous or allogeneic scapula can restore stability,functions,and improve appearance.