Astuti Pitarini
Abstrak :
ABSTRAK
Pendahuluan Penggunaan megaprostesis sebagai pilihan dalam manajemen LSS
memberikan harapan baru bagi pasien tumor tulang di Indonesia. Namun, sampai
saat ini belum ada data hasil luaran dari tata laksana ini.
Metode Penelitian ini merupakan prospektif observational pada 34 pasien tumor
tulang di RS Cipto Mangunkusumo pada tahun 2011-2015. Diagnosis ditegakkan
melalui Clinical Pathological Conference. Evaluasi pascaoperasi dilakukan pada
bulan ke-3, 6, 9, 12, 24, 36, dan 48 dengan menggunakan skoring dari MSTS.
Luaran onkologi dievaluasi dengan adanya rekurensi dan metastasis jauh.
Komplikasi berupa infeksi, dislokasi, cedera saraf dan pembuluh darah, serta
gangguan mekanisme ekstensor juga dievaluasi.
Hasil Dua orang ahli bedah muskuloskeletal onkologi melakukan operasi LSS dan
rekonstruksi dengan megaprostesis. Dua pasien dieksklusi karena keputusan
intraoperatif untuk memakai non modular endoprostesis. Kehilangan darah
intraoperatif memiliki median (RAK) 890,0 (700,0?1200,0) ml. Skor MSTS
sebagian besar pasien menunjukkan kategori baik dan sangat baik, yaitu 67.9%
baik pada MSTS 6 bulan, 79,2% baik pada MSTS 9 bulan, 63.4% sangat baik
pada 12 bulan, 90% sangat baik pada 24 bulan dan 100% sangat baik pada MSTS
36 bulan. Terdapat hubungan bermakna antara karakteristik pasien yaitu jenis
tumor (p=0,001), usia (p=0,039), jenis kelamin (p=0,049), dan hasil laboratorium
ALP (p=0,031) dengan luaran fungsional MSTS 3 bulan. Terdapat hubungan
bermakna antara karakteristik pasien yaitu perdarahan intraoperatif (p=0,013) dan
ALP (p=0,009) dengan mortalitas; dan juga antara tumor tulang yang menjalani
rekonstruksi jaringan lunak ekstensif dengan komplikasi (p=0,019) namun antara
lokasi tumor dan komplikasi tidak terdapat hubungan bermakna.
Kesimpulan Luaran fungsional pada pasien yang dilakukan rekonstruksi
megaprostesis adalah baik dan sangat baik sehingga dapat menjadi tatalaksana
pilihan bagi pasien tumor tulang yang akan menjalani LSS. Luaran onkologi pada
pasien yang dilakukan prosedur LSS baik dengan rendahnya rekurensi lokal, metastasi, dan komplikasi. ABSTRACT
Introduction Advancement in bone tumor management has elaborated surgeon?s
choice of treatment not merely sentenced the patients into a limb ablation.
Likewise, patients with bone tumors, regardless its malignant nature and limited
survival time, had an equal privileges to opt for LSS to experience a better quality
of life. In this study, we manage to evaluate the functional and oncologic outcome
of lower extremity bone tumors following a LSS using megaprosthesis.
Methods Thirty-four patients with lower extremity bone tumors were
prospectively reviewed between 2011 and 2015 in a tertiary referral general
hospital. All patients were managed through a Clinical Pathology Conference.
Functional outcome was evaluated using MSTS score and follow up was recorded
at 3, 6, 12 months; and 2, 3, 4 years.
Results Two orthopedic musculoskeletal oncologic surgeons were performing the
surgeries. Two patients were excluded because the final instruments used were
not a modular type. The final result of functional score was good to excellent with
67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,
90% excellent at 24 months and 100% excellent at 36 months. Complications
occurred and varied. A statistical significant result was found between age
(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months
functional outcome; between intraoperative blood loss (p=0,013) and mortality,
as well as SAP with mortality (p=0,009); between tumor that underwent extensive
soft tissue reconstruction procedure and complication (p=0,019).
Conclusion Megaprosthesis reconstruction in bone tumors gives a good and
excellent result, which provides orthopaedic oncologic surgeons a rationalization
to make a selective decision-making in tumor cases regardless its survival and
tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s
choice of treatment not merely sentenced the patients into a limb ablation.
Likewise, patients with bone tumors, regardless its malignant nature and limited
survival time, had an equal privileges to opt for LSS to experience a better quality
of life. In this study, we manage to evaluate the functional and oncologic outcome
of lower extremity bone tumors following a LSS using megaprosthesis.
Methods Thirty-four patients with lower extremity bone tumors were
prospectively reviewed between 2011 and 2015 in a tertiary referral general
hospital. All patients were managed through a Clinical Pathology Conference.
Functional outcome was evaluated using MSTS score and follow up was recorded
at 3, 6, 12 months; and 2, 3, 4 years.
Results Two orthopedic musculoskeletal oncologic surgeons were performing the
surgeries. Two patients were excluded because the final instruments used were
not a modular type. The final result of functional score was good to excellent with
67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,
90% excellent at 24 months and 100% excellent at 36 months. Complications
occurred and varied. A statistical significant result was found between age
(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months
functional outcome; between intraoperative blood loss (p=0,013) and mortality,
as well as SAP with mortality (p=0,009); between tumor that underwent extensive
soft tissue reconstruction procedure and complication (p=0,019).
Conclusion Megaprosthesis reconstruction in bone tumors gives a good and
excellent result, which provides orthopaedic oncologic surgeons a rationalization
to make a selective decision-making in tumor cases regardless its survival and
tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s
choice of treatment not merely sentenced the patients into a limb ablation.
Likewise, patients with bone tumors, regardless its malignant nature and limited
survival time, had an equal privileges to opt for LSS to experience a better quality
of life. In this study, we manage to evaluate the functional and oncologic outcome
of lower extremity bone tumors following a LSS using megaprosthesis.
Methods Thirty-four patients with lower extremity bone tumors were
prospectively reviewed between 2011 and 2015 in a tertiary referral general
hospital. All patients were managed through a Clinical Pathology Conference.
Functional outcome was evaluated using MSTS score and follow up was recorded
at 3, 6, 12 months; and 2, 3, 4 years.
Results Two orthopedic musculoskeletal oncologic surgeons were performing the
surgeries. Two patients were excluded because the final instruments used were
not a modular type. The final result of functional score was good to excellent with
67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,
90% excellent at 24 months and 100% excellent at 36 months. Complications
occurred and varied. A statistical significant result was found between age
(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months
functional outcome; between intraoperative blood loss (p=0,013) and mortality,
as well as SAP with mortality (p=0,009); between tumor that underwent extensive
soft tissue reconstruction procedure and complication (p=0,019).
Conclusion Megaprosthesis reconstruction in bone tumors gives a good and
excellent result, which provides orthopaedic oncologic surgeons a rationalization
to make a selective decision-making in tumor cases regardless its survival and
tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s
choice of treatment not merely sentenced the patients into a limb ablation.
Likewise, patients with bone tumors, regardless its malignant nature and limited
survival time, had an equal privileges to opt for LSS to experience a better quality
of life. In this study, we manage to evaluate the functional and oncologic outcome
of lower extremity bone tumors following a LSS using megaprosthesis.
Methods Thirty-four patients with lower extremity bone tumors were
prospectively reviewed between 2011 and 2015 in a tertiary referral general
hospital. All patients were managed through a Clinical Pathology Conference.
Functional outcome was evaluated using MSTS score and follow up was recorded
at 3, 6, 12 months; and 2, 3, 4 years.
Results Two orthopedic musculoskeletal oncologic surgeons were performing the
surgeries. Two patients were excluded because the final instruments used were
not a modular type. The final result of functional score was good to excellent with
67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,
90% excellent at 24 months and 100% excellent at 36 months. Complications
occurred and varied. A statistical significant result was found between age
(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months
functional outcome; between intraoperative blood loss (p=0,013) and mortality,
as well as SAP with mortality (p=0,009); between tumor that underwent extensive
soft tissue reconstruction procedure and complication (p=0,019).
Conclusion Megaprosthesis reconstruction in bone tumors gives a good and
excellent result, which provides orthopaedic oncologic surgeons a rationalization
to make a selective decision-making in tumor cases regardless its survival and
tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s
choice of treatment not merely sentenced the patients into a limb ablation.
Likewise, patients with bone tumors, regardless its malignant nature and limited
survival time, had an equal privileges to opt for LSS to experience a better quality
of life. In this study, we manage to evaluate the functional and oncologic outcome
of lower extremity bone tumors following a LSS using megaprosthesis.
Methods Thirty-four patients with lower extremity bone tumors were
prospectively reviewed between 2011 and 2015 in a tertiary referral general
hospital. All patients were managed through a Clinical Pathology Conference.
Functional outcome was evaluated using MSTS score and follow up was recorded
at 3, 6, 12 months; and 2, 3, 4 years.
Results Two orthopedic musculoskeletal oncologic surgeons were performing the
surgeries. Two patients were excluded because the final instruments used were
not a modular type. The final result of functional score was good to excellent with
67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,
90% excellent at 24 months and 100% excellent at 36 months. Complications
occurred and varied. A statistical significant result was found between age
(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months
functional outcome; between intraoperative blood loss (p=0,013) and mortality,
as well as SAP with mortality (p=0,009); between tumor that underwent extensive
soft tissue reconstruction procedure and complication (p=0,019).
Conclusion Megaprosthesis reconstruction in bone tumors gives a good and
excellent result, which provides orthopaedic oncologic surgeons a rationalization
to make a selective decision-making in tumor cases regardless its survival and
tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.
Fakultas Kedokteran Universitas Indonesia, 2015
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