Conspectus: En bloc surgery for osteogenic sarcoma: Analysis and review
This is the first series ever done and the largest follow-up of patients with limb operations done by one surgeon. Subsequent reports from Memorial Hospital involve another group of surgeons, and the survival rates are largely comparable. This series demonstrates that, with more experience, local recurrences can probably be reduced from the present 5.5%. This has also been shown in Vienna by Salzer, whose early local recurrence rate was 30% and, with experience, was later lowered to 15%. The early experience of the Mayo Clinic is with a 24% local recurrence rate for tumors with soft tissue masses (2A type). The early series done by Dr. Francis had an overall survival of <25%, but these cases had less radical surgery and no chemotherapy. In our series, most, but not all, had chemotherapy (three patients refused). These figures document that en bloc procedures can have good overall survival, which tends to improve with more radical local surgery. They also demonstrate that the rate of local recurrence decreases with surgical experience and that these operations should not be undertaken by the inexperienced tumor surgeon. The use of local expanding prosthetic device is generally unnecessary in these usually tall patients. The important factor in choosing a surgeon is that surgeon's published postoperative survival rates and not the type of prosthesis he uses. If a medical center's cure rate is not published, the referring physician should certainly be hesitant to direct a patient there for limb-sparing surgery. All prostheses are available to anyone, but the overriding statistic must be the survival rate of patients.