COMPLICATIONS AND SURGICAL INDICATIONS IN 144 CASES OF NONMETASTATIC OSTEOSARCOMA OF THE EXTREMITIES TREATED WITH NEOADJUVANT CHEMOTHERAPY

From September 1986 to December 1989, 144 patients with osteosarcoma o f the extremities were treated with combined surgery and neoadjuvant c hemotherapy. The disease-free survival was 79% for good responders (ne crosis greater than 90%) and 72% for poor responders (necrosis less th an 90%), and the local recurrence rate was low. Improvement in long-te rm prognosis and the increase of limb-sparing surgery determine a high er rate of immediate and late complications. Most of the complications were observed in limb-salvage procedures; 63% of these procedures pre sented one or more complications. In nine rotationplasties, there were four complications, and in 13 amputations no complications were obser ved. Therefore, 55% of patients were affected by surgical complication s. Twenty-eight complications were considered minor (not requiring sur gery), whereas 77 complications were major. Functional results, evalua ted according to Enneking's new system, were higher than 50% in two th irds of the limb-salvage procedures. Complications in limb-salvage pro cedures are more influenced by the type of reconstruction than by the surgical procedure used. Probably the most troublesome consequence of surgical complications in osteosarcoma is the deviation or delay in ad ministering postoperative chemotherapy, which jeopardizes survival.