Wide local excision is an operation to remove a bone tumour along with a surrounding margin of healthy tissue. It is the standard surgical treatment for primary malignant bone tumours (sarcomas) and some aggressive benign tumours.
An incision is made over the tumour, carefully planned to allow complete removal. The tumour is excised en bloc (as a single piece) with a cuff of normal tissue around it. The biopsy tract is removed with the specimen. The resulting bone defect may be reconstructed with an endoprosthesis (metal implant), bone graft, or a combination. The operation is complex and may take three to six hours depending on the location and reconstruction needed.
Surgery is the primary curative treatment for bone sarcomas (osteosarcoma, chondrosarcoma, Ewing's sarcoma after chemotherapy). The goal is complete removal with clear margins while preserving as much limb function as possible.
For some sarcomas, chemotherapy and/or radiotherapy may be used to shrink the tumour before surgery (neoadjuvant therapy). Radiotherapy alone may be used when surgery is not possible. Amputation is a last resort when limb salvage is not feasible.
Staging investigations (MRI, CT, bone scan, PET-CT). Multidisciplinary team discussion. Neoadjuvant chemotherapy may precede surgery. This is performed at specialist sarcoma centres.
Complete removal of the tumour with the best chance of cure. Limb salvage is achievable in approximately 85-90% of bone sarcoma cases. Reconstruction aims to preserve function.
This is a major operation with a prolonged rehabilitation.
Some loss of function is expected depending on the location and extent of resection.
Significant blood loss. Transfusion is often needed.
Risk is higher with metallic reconstruction and in patients receiving chemotherapy.
The tumour may recur locally despite wide margins.
Particularly after radiotherapy or chemotherapy.
May be unavoidable depending on tumour proximity.
Around or through the reconstruction.
Endoprosthetic reconstructions may wear, loosen, or break over time.
General anaesthesia. Significant blood loss requires transfusion capability. Cell salvage is usually avoided in oncology.
Hospital stay one to two weeks. Rehabilitation depends on the location and reconstruction. Physiotherapy for months. Return to light activity at two to three months. Full recovery six to twelve months. Long-term follow-up is essential.
Regular oncology surveillance: X-rays and CT scans every three months for the first two years, then six-monthly for five years, then annually. Ongoing monitoring of the reconstruction.
Limb salvage is achieved in approximately 85-90% of bone sarcoma cases. Amputation is only considered when the tumour involves critical structures that cannot be sacrificed.
A custom-made or modular metal implant that replaces the removed section of bone and the adjacent joint. It provides immediate structural support and allows early mobilisation.