To evaluate the long term functional and the oncological outcomes of patients who underwent scapulectomy as a limb saving procedure for various tumours of the scapula.

A retrospective study was done in twenty-five patients who underwent scapulectomy for various tumours between 1989 and 2005. We describe twenty-three patients of scapular tumours who were followed up for a minimum of two years after surgery. Nineteen patients had malignant neoplasms of which chondrosarcoma was commonest, followed by Ewing’s sarcoma. Surgical staging was done using Enneking’s system; with stage II B being the commonest. Eight patients underwent subtotal scapulectomy of Malawer Type IIA and fifteen patients underwent total scapulectomy (Type III A). All patients with Ewing’s and Osteosarcoma received neoadjuvant chemotherapy.

With a follow-up ranging from 25–202 months, functional prognosis and oncological outcomes were evaluated for all patients. Two patients had superficial wound infections requiring antibiotics and one had skin necrosis requiring skin cover. Three patients died of pulmonary metastasis and the fourth patient died of local recurrence complicated by multiple metastasis. Functional results were analysed using Musculoskeletal Tumour Society scoring system. The Kaplan Meier 5-year survival computed in 19 patients with malignant tumours was 75.9%.

Scapulectomy is a more realistic option for bone and soft tissue tumours around shoulder girdle. It permits a curative, non-ablative, alternative to forequarter amputation in carefully selected patients.

Purpose Of The Study: To find the functional and oncological outcome of patients who underwent limb salvage surgery and custom mega prosthesis for Malignant Fibrous Histiocytoma of bone.

Methods And Results: Twenty patients with histologically diagnosed Malignant Fibrous Histiocytoma of bone were treated by resection and reconstruction with custom mega prosthesis between May 1991 and December 2002. The average age was 42 and two-thirds of the patients were males. Majority of the tumours were located around the knee and were in Stage II disease of the Enneking system. Wide margins of resection were achieved in 18 patients and reconstruction was done with total knee prosthesis in patients with distal femoral and proximal tibial tumours. The proximal humeral and proximal femoral sites were reconstructed with their respective prosthesis. Fourteen patients treated after 1996 received chemotherapy. With an average follow-up of 57.7 months, 4 patients had amputation for local recurrence and five patients died of disease. Two patients had fracture of prosthesis necessitating revision of prosthesis in one. Functional result was excellent in 5 patients and good in 9 patients. The Kaplan-Meier 5-year survival rates of the patients treated without chemotherapy and with chemotherapy were 50% and 75.8% respectively.

Conclusion: MFH is an aggressive malignant tumour with a poor prognosis. A combined approach using neoadjuvant chemotherapy together with adequate surgical margins improves survival.