Surgery for Osteosarcoma

Osteosarcoma can only be cured with surgery. The main types of surgery for osteosarcomas that start in the arms or legs are surgery to remove the cancer without removing the arm or leg (limb-salvage surgery) and amputation.

• Limb-salvage (limb-sparing) surgery - The surgeon removes the entire tumor but not the nearby tendons, nerves, and blood vessels. The surgeon replaces the bone that was removed with a bone graft or artificial replacement (endoprosthesis). This is a very complex operation and must be done by surgeons with special skills and experience.
  
  • Bone graft - The surgeon transplants a piece of bone to the site where the cancer was removed. The bone may come from the patient (autologous bone graft) or from someone else (allogeneic bone graft).
  • Endoprosthesis - An endoprosthesis is an artificial replacement for bone within the body that is made of metal or other materials. When an endoprosthesis is implanted into a growing child, it is designed to lengthen as the child grows; this sometimes, but not always, requires additional surgeries. Some “growing” prostheses have a tiny device that can lengthen the prosthesis whenever needed to make room for the child’s growth.
    
• Amputation - If the tumor has grown into the nerves and/or blood vessels, it might not be possible to save the arm or leg. In this case, amputation, or removal of all or part of the limb along with the cancer, may be the only option. The surgeon plans the operation so that the muscles and skin that are left form a cuff around the amputated bone. The cuff fits into the end of an artificial (prosthetic) arm or leg.
  
  • Reconstructive surgery in the leg - Sometimes, if the leg is amputated at mid-thigh, the lower leg and foot is rotated and attached to the thigh bone. This procedure is called rotationplasty. The ankle then serves as a knee joint. The patient will need a prosthesis to extend the leg.
  • Reconstructive surgery in the arm - If the osteosarcoma is in the upper arm, the lower arm may be reattached after the tumor is removed so that the patient has a working arm, even though it is much shorter.
  • Reconstructive surgery in the jaw - If the osteosarcoma is in the lower jaw bone, the surgeon may remove the lower half of the jaw and replace it later with bones from other parts of the body.
    
• Surgery to remove lung metastases - If the osteosarcoma has spread (metastasized) to the lungs, the surgeon will try to remove these tumors. This is usually done by wedge resection, in which the surgeon removes a very small part of the lung. But sometimes the entire lung must be taken out to remove all of the cancer. Before deciding whether to operate, the surgeon considers the number of tumors, whether they are located in one or both lungs, their size, their response to chemotherapy, and the patient’s general condition. In some cases, tumors can be removed from both lungs at the same time. In other cases, the surgeon may remove tumors from the two lungs in separate operations.