Surgery is undertaken to remove all signs of Osteosarcoma possible from a patient’s body. The rule of thumb in osteosarcoma is that if a tumor can be removed it should be; as survival rates rise dramatically with complete removal of all disease. Occasionally a site of disease will make it unresectable (cannot be removed via surgery due to location or size) then a different approach and protocol will often be considered.
Depending on the location of the tumor, the surgical options may vary. For tumors in limbs, the options typically fall into three categories: limb-salvage, amputation or rotationplasty. Each has its own pros and cons, but it is very important for a patient, family and the treatment team to thoughtfully discuss surgical options with their orthopedic oncologist.
Limb-Salvage or limb-sparing (LSS) is a surgery that removes the cancerous segment of bone and any surrounding tissue that it may be touching. The bone is then replaced with a cadaver bone (bone harvested from another part of the body or person) or endoprosthetic (metal parts that are used in place of the bone taken out).
Rotationplasty is a special type of amputation. Tumors just below or above-the-knee in your femur require an above-knee amputation (AKA). This can make mobility, comfort, and appearance a little more challenging than a below-knee amputation (BKA).
When a rotationplasty is done, the tumor and associated bone segment along with the knee joint are removed (amputated) and the bottom portion of the leg is reattached. Therefore, rotationplasty is an alternative to losing your knee, as the lower leg, including the foot, is rotated and attached to the remaining upper leg bone.
Morgan from Montana says, “Surgery is a tough time decision no matter what you opt for. I had a rotationplasty at age 5 and am 100% sure it was the right choice for me. Keyword being “me”. Everyone is different, weigh the options and go with what will let you be you in the short term but also long term.”
The lungs are the most common location for osteosarcoma to metastasize. Similar to primary tumor location the treatment is usually a combination of chemotherapy and surgery to remove the tumor(s). There are a couple different types of surgical procedures used to remove osteosarcoma from the lungs
A thoracotomy is an invasive surgical procedure that allows the surgeon to deflate the lung(s) and manually palpate the lung tissue with her/ his fingers to find nodules in the thoracic cavity. While it is more invasive, it is often seen as the preferable surgery as a surgeon can find and remove more nodules than are visually seen on a CT scan or through a thoracoscopy. Removing more nodules has the potential to decrease additional disease being found after surgery.
Thoracoscopy/pleuroscopy is a minimally invasive procedure that allows access to the lungs or pleural space using a combination of viewing and working instruments (clamps, scalpels, etc.). It allows for internal examination, biopsy, and/or resection of disease or masses within the pleural cavity and thoracic (lung) cavity. Thoracoscopy may be performed either under general anesthesia or under sedation with local anesthetic.
Recovery time from any osteosarcoma surgery is significant. Generally, surgeons will have to determine when enough recovery has taken place to restart chemotherapy. Chemotherapy is a life-saving treatment, yet can slow down recovery from surgery. It is a delicate balance determining how long to heal from surgery without allowing new disease to grow before resuming chemo. Management of pain, beginning movement and physical therapy can all be very draining and time-consuming. Remember that focus during this time should be on recovery and healing socialization, school, and activities, while important, should be seen as second to rest and recovery. Listen to your doctor- this is a very unique surgery; it is not similar to a knee or shoulder replacement. Your child’s needs for mobility and physical therapy will be significant. Being sure to gain mobility and weight bearing at appropriate times to maximize mobility while minimizing potential injury is crucial.
Cate from Chicago suggests, “Surgery is a major part of saving the life of your OsteoWarrior. No matter what challenges surgery may bring, your family WILL find a new normal and be able to thrive.”
*No two osteosarcoma patients are the same, therefore there is no substitute for the expert care of your medical team. This is not meant to replace the guidance of your oncology team. It is meant to share resources, information and support.