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Musculoskeletal Cancer Surgery: Treatment of Sarcomas and Allied Diseases

Weeks later, in the sun-drenched clinic, Elias watched Maya. She wasn't playing the violin yet, but she could grip a pencil. She reached out with her right arm—the arm that shouldn't have been there—and handed him a drawing. It was a messy, colourful sketch of a tree with deep roots and wide branches.

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Surgical Techniques

4.3. Resection Techniques

| Technique | Indication | Key Technical Pearls (Malawer) | |---------------|----------------|------------------------------------| | En bloc wide resection | Most high‑grade sarcomas | – Use “wide” margins measured on MRI;
– Include a cuff of healthy tissue;
– Preserve uninvolved neurovascular bundles when possible. | | Compartmental resection | Tumors confined to a known anatomic compartment (e.g., femoral shaft) | – Remove the entire compartment;
– Ligate and resect the associated periosteum. | | Extra‑compartmental (trans‑compartmental) resection | Tumors breaching compartment boundaries | – Extend resection across the breached plane;
– May require vascular reconstruction. | | Marginal resection | Low‑grade lesions where limb function is paramount | – Accepts a microscopically positive margin in selected cases;
– Often combined with adjuvant radiotherapy. | | Amputation | Unresectable neurovascular involvement, massive bone loss, or patient preference | – Level dictated by tumor extent;
– Preserve as much limb length as feasible (e.g., through‑knee vs. transfemoral). | It was a messy, colourful sketch of a

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Surgical Principles

Key Themes

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