What is the role of resection in the treatment of osteosarcoma?

Updated: Dec 04, 2018
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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Answer

The primary aim of definitive resection is patient survival. Accordingly, margins on all sides of the tumor must contain normal tissue (wide margin). 

Wide resection is the goal for patients in whom primary tumor resection is contemplated. Simply defined, wide resection means that the entire malignant tumor has been surgically excised and that there is no remaining microscopic evidence of tumor cells at the resection margins (ie, that the margins are negative). Over the years, many authors have suggested varying and arbitrary amounts of the normal tissue cuff to remove along with the primary tumor to increase the likelihood of negative margins.

There is no universally accepted definition of the appropriate thickness of the normal cuff. Technically, a wide margin still exists even if the distance between normal tissue and tumor is onle one cell thick. Oncologically, the width achieved is less important (limb-sparing surgery vs amputation) than the achievement of a negative margin. In other words, a limb-sparing surgery without wide margins could do the patient less of a service than an amputation with wide margins. This would apply in most cases where maximal preservation of life is the primary goal.

Radical margins, defined as removal of the entire involved compartment (bone, joint to joint; muscle, origin to insertion), are usually not required for cure. A less-than-wide margin (marginal or intralesional margin) may be functionally helpful as a debulking therapy, but intrinsically, it will not be locally curative. Amputation may be the treatment of choice in some circumstances.


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