Intermediate results and functional evaluation of limb‐salvage surgery for osteosarcoma: An intergroup study in Japan

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Abstract
This is a 2‐7‐year follow‐up report by 21 institutes in Japan concerning limb‐salvage surgery for osteosarcoma. Between 1980 and 1985, 248 patients with osteosarcoma were treated, and 105 patients had limb‐salvage surgery. The percentage of cases treated by limb‐salvage surgery increased with each year. The cumulative survival rate was 71% at 5 years in the limb‐salvage group, and in the amputation group it was 46%; this indicates that cases for limb‐salvage surgery were carefully evaluated for this procedure. In limb‐salvage patients, tumor resection was classified according to the surgical margin as intralesional excision, marginal excision, wide‐with‐marginal resection, wide resection, and radical resection. Wide resection was performed in most cases as the method of choice. Local recurrence was seen in 13 cases (12%). The overall functional evaluations by Enneking's system showed that the number of results rated excellent or good was relatively high in the early follow‐up period, but this decreased later on, and cases rated fair or poor increased as the years passed. This was mainly due to postsurgical complications (44 cases). We identify a few problems in the functional evaluation system used now and suggest a reform of the system, so that physical and mental factors would evaluated separately.