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Results in the surgical treatment of aneurysmal bone cysts – A retrospective data analysis - 14/10/21

Doi : 10.1016/j.otsr.2021.103095 
Kevin Döring a, , Stephan Puchner a, Klemens Vertesich a, Philipp T. Funovics a, Gerhard Hobusch a, Irene Sulzbacher b, Catharina Chiari a, Reinhard Windhager a
a Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna 
b Austria Department of Pathology, Medical University of Vienna, Vienna, Austria 

Corresponding author. Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Wien, Austria.Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Vienna General HospitalWähringer Gürtel 18-20WienA-1090Austria
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 14 October 2021

Abstract

Background

Aneurysmal bone cysts (ABC) are benign tumors mostly occurring in children and young adults. Different open and minimal invasive surgical approaches have been proposed for the treatment of ABCs and yet no consensus is defined to date. The aim of this study was to retrospectively review data of a large single center series of ABCs with patients treated by open curettage with or without filling of the cavity or en-bloc resection.

Questions/purposes We asked: (1) What was the local recurrence rate of ABC after surgical treatment at our institution? (2) What were positive or negative predictors for local recurrence? (3) Was there a benefit from adjuvant burring, phenolization or filling, respectively? (4) Where there changes in recurrence free survival in different time periods of primary surgery?

Methods

By retrospective data analysis of the Vienna Bone and Soft Tissue Tumor Registry, 123 patients surgically treated for primary aneurysmal bone cysts were identified. After exclusion of 33 patients (27%) due to a postoperative follow up below one year, 90 patients who were treated for primary ABCs between 1986 and 2009 were evaluated. These included 50 males and 40 females with a mean age of 16 years (SD 10 years; range: 2 to 51 years). The mean follow-up was 99 months. (SD 72 months, range: 13 to 329 months)

Results

Curettage was performed in 84 patients, while 45 patients received adjuvant phenolization. Local recurrence occurred in 28 patients after a mean time of 16 months, with a corresponding local recurrence free survival (RFS) of 83% after one year, 77% after 2 years and 66% after 5 years. ABCs located in hands and feet (p=0.044) showed a superior RFS, while younger patients (p=0.001) displayed an inferior RFS. Regarding adjuvant surgical techniques, mechanical cavity burring (p=0.004) and filling with autologous cancellous bone graft (p=0.024) showed protective effects on RFS. Patients treated between 1986 and 1999 (n=47) had a higher RFS than patients treated between 2000 and 2009 (n=43, p=0.011), as surgeons and surgical indications changed over time.

Conclusion

Although curettage, burring, phenolization and reconstruction with bone grafts came with a relatively high risk of local recurrence, open surgery is still justified in aggressively growing ABCs of critical localizations.

Level of evidence

IV; therapeutic study.

Le texte complet de cet article est disponible en PDF.

Keywords : Aneurysmal bone cyst, Tumor like lesion, ABC, Recurrence, Tumor orthopaedics


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© 2021  The Author(s). Publié par Elsevier Masson SAS. Tous droits réservés.
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