Complications after limb salvage surgeries for musculoskeletal malignancies: 10-year experience of the main sarcoma center in Bulgaria

Abstract

Introduction: Limb salvage surgery is currently the most frequently used treatment option in Bulgaria for individuals with musculoskeletal malignancies. Clinical data about complications from these procedures is limited in the country, with only a few studies currently available. Aim: The aim of our study is to analyze complication rates and patterns in Bulgarian patients treated with limb salvage surgery for musculoskeletal malignancies. Materials and methods: Our series consist of a retrospective review of 43 patients with musculoskeletal malignancies, who underwent limb salvage surgeries at Boycho Boychev University Orthopedic Hospital in Sofia, Bulgaria, over a period of 10 years. For staging, we used the AJCC and Enneking’s staging systems for malignant musculoskeletal tumors. Functionality was assessed with the MSTS system. Assessment of complications was done with a modified Clavien-Dindo classification for surgical complications and Henderson’s classification of failure of limb salvage after reconstructive surgery. Results: The mean follow-up time for the series is 40 months (range 12 to 120 months). At the current follow-up, the overall survival rate for the series is 72%. The overall complication rate for the series is 72% and the surgical revision rate is 46.5%. Of the encountered complications, 84% were classified as grade Ⅲb using the Clavien-Dindo classification. Conclusion: Bulgarian patients treated with limb salvage for musculoskeletal malignancies have high complication rates, with no clear prevalence between mechanical and non-mechanical complication patterns. Many of the encountered complications are severe and require additional surgical management.