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. 2023 Dec 1;105-B(12):1314-1320.
doi: 10.1302/0301-620X.105B12.BJJ-2023-0552.R1.

Oncological and functional outcomes after resection of malignant tumours of the scapula

Samuel E Broida  1 , Mikaela H Sullivan  1 , Jonathan D Barlow  1 , Mark Morrey  1 , Maurizio Scorianz  2 , Eric R Wagner  3 , Joaquin Sanchez-Sotelo  1 , Peter S Rose  1 , Matthew T Houdek  1
Affiliations

Oncological and functional outcomes after resection of malignant tumours of the scapula

Samuel E Broida et al. Bone Joint J. .

Abstract

Aims: The scapula is a rare site for a primary bone tumour. Only a small number of series have studied patient outcomes after treatment. Previous studies have shown a high rate of recurrence, with functional outcomes determined by the preservation of the glenohumeral joint and deltoid. The purpose of the current study was to report the outcome of patients who had undergone tumour resection that included the scapula.

Methods: We reviewed 61 patients (37 male, 24 female; mean age 42 years (SD 19)) who had undergone resection of the scapula. The most common resection was type 2 (n = 34) according to the Tikhoff-Linberg classification, or type S1A (n = 35) on the Enneking classification.

Results: The ten-year disease-specific survival was 76%. High tumour grade (hazard ratio (HR) 4.27; p = 0.016) and a total resection of the scapula (HR 3.84; p = 0.015) were associated with worse survival. The ten-year metastasis-free and local recurrence-free survivals were 82% and 86%, respectively. Total scapular resection (HR 6.29; p = 0.004) was associated with metastatic disease and positive margins were associated with local recurrence (HR 12.86; p = 0.001). At final follow-up, the mean shoulder forward elevation and external rotation were 79° (SD 62°) and 27° (SD 25°), respectively. The most recent functional outcomes evaluated included the mean Musculoskeletal Tumor Society Score (76% (SD 17%)), the American Shoulder and Elbow Score (73% (SD 20%)), and the Simple Shoulder Test (7 (SD 3)). Preservation of the glenoid (p = 0.001) and scapular spine (p < 0.001) improved clinical outcomes; interestingly, preservation of the scapular spine without the glenoid improved outcomes (p < 0.001) compared to preservation of the glenoid alone (p = 0.05).

Conclusion: Resection of the scapula is a major undertaking with an oncological outcome related to tumour grade, and a functional outcome associated with the status of the scapular spine and glenoid. Positive resection margins are associated with local recurrence.

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Conflict of interest statement

J. D. Barlow reports personal and institutional royalties and consulting payments from Stryker, unrelated to this study. M. Houdek reports consulting payments from Link Orthopedics, unrelated to this study, and a leadership or fiduciary role in the Musculoskeletal Tumor Society, the Connective Tissue Oncology Society, and the Sarcoma Alliance for Research through Collaboration. P. S. Rose reports a leadership or fiduciary role in the International Society of Limb Salvage, the Sacral Tumor Study Group, and the Journal of the American Academy of Orthopaedic Surgeons. J. Sanchez-Sotelo reports grants from Stryker, royalties from Stryker, Oxford University Press, and Elsevier, consulting payments from Stryker, Acumed, and Exactech, speaker payments from the Journal of Shoulder and Elbow Surgery, a leadership or fiduciary role in American Shoulder and Elbow Surgeons, and stock or stock options in Precision OS, Orthobullets, and PSI, all of which are unrelated to this study. E. Wagner reports consulting fees from Stryker, Zimmer Biomet, Acumed, and Osteoremedies, all of which are unrelated to this study.

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