Outcomes of hemicortical resection and reconstruction with liquid nitrogen-treated autograft for high-grade sarcomas: A retrospective case series

Abstract

Hemicortical resection (HCR) is a limb salvage option for eccentrically located bone sarcomas that allows preservation of native bone stock and nearby joint anatomy. Evidence on outcomes in high-grade extremity sarcomas remains limited. We performed a retrospective case series of consecutive patients undergoing HCR for high-grade primary malignant bone tumors of the extremities. Collected variables included demographics, tumor type and location, systemic therapy, local radiotherapy, radiographic union, time to union, complications, local recurrence, distant metastasis, survival status, and last follow-up. Five patients were included (mean age 14.2 years; 3/5 female). Diagnoses were Ewing sarcoma (n = 3) and osteosarcoma (n = 2). Sites were distal femur (n = 2), proximal tibia (n = 1), distal tibia (n = 1), and tibial shaft (n = 1). One patient received local radiotherapy. Union was achieved in all cases. Median time to union was 8.2 months (mean 11.1; range 4.4-18.9). Median follow-up was 20.8 months (mean 19.3; range 11.7-23.4). Complications included one infection treated with antibiotics and one late implant exposure requiring debridement and flap coverage. No local recurrences, distant metastases, or deaths were observed at last follow-up. In this small series, HCR with biological reconstruction achieved universal union and a low early complication rate. No local recurrence, distant metastasis, or death was observed during the available follow-up; however, oncologic safety cannot be inferred from this limited cohort, and larger studies with longer follow-up are required. INTRODUCTION tumor-bearing autograft devitalized by methods such as liquid nitrogen (LN), pasteurization, irradiation, 5-7 Limb salvage surgery has become the standard of care or ethanol . Among these, LN-treated autograft is for most localized high-grade extremity sarcomas widely used because it delivers rapid, deep cytocidal when wide margins are achievable and function can temperatures while p