For benign (benign) tumors, the goal is complete excision (curettage).For malignant (malignant) tumors, the goal is removal in healthy tissue with a safety margin. The following forms of surgical therapy are available and are performed depending on the exact tumor type:
- Biopsy (tissue removal) to clarify the dignity (biological behavior of tumors; i.e., whether they are benign (benign) or malignant (malignant)).
- Embolization (artificial occlusion of blood vessels by administering, for example, liquid plastics, plastic beads, or fibrin sponges via a catheter) – procedure performed on tumors with a large number of vessels, which is intended to reduce the risk of bleeding
- Intralesional resection – method of choice for most benign (benign) bone tumors.
- Procedure: Opening of the tumor → curettage → filling of the bone defect with autologous (from the same individual) bone material (e.g., from the iliac crest), stabilization with metallic implants (intramedullary nail, angle plate) if necessary.
- Depending on the situation, a so-called bone cement seal can be used temporarily → Advantage: the tumor cells of the marginal zones are killed by the polymerization heat of the cement. Recurrences (recurrence of the disease) at the bone/cement interface can thus be diagnosed more easily. If the patient is one to two years free of recurrence, the bone cement can be removed again and replaced with autologous cancellous bone.
- In addition to bone cement, the following additional adjuvants (effect enhancers) that contribute to a lower recurrence rate have been shown to be effective:
- Marginal resection
- Procedure: Removal of the tumor in its marginal zone
- Wide resection – method of choice for malignant (malignant) bone tumors.
- Procedure: wide and radical resection (surgical removal) of the tumor with a safety margin of 5 cm (proximal (toward the center of the body) and distal (away from the center of the body)).
- After tumor removal, osteosynthesis (insertion of a spongiosaplasty) or reconstruction of the resulting bone defect is performed, e.g., in the form of a tumor endoprosthesis, a bone graft, or muscle, nerve, and vascular replacement plastics. For children, growing endoprostheses (joint replacement) are suitable.
- Through the use of mega endoprostheses amputations of the affected limb are now rarely necessary (“Ultima ratio” (last resort)).
Osseous metastases (bone metastases) are removed surgically. As a rule, a cure is no longer possible at this stage of the tumor disease. Through the intervention, however, at least the quality of life of the affected person can be improved or prolonged.If a fracture is imminent or occurs, the focus is on stabilization. After an intralesional or marginal resection, a composite osteosynthesis with bone cement and plate or intramedullary nail or endoprosthesis is inserted. Finally, radiatio (radiation therapy) is performed. Bone tumors such as osteoid osteoma or osteoblastoma (benign (benign) bone tumors) have a nidus (focus) inside from which the pain originates. The challenge in the surgical procedure is hitting the nidus in the bone sclerosis that may be present. The nidus must be completely removed. The bone sclerosis surrounding the nidus is left behind.Caveat: Curettage (excision) is not recommended because it is often associated with recurrence (recurrence of the disease). Since damage to muscles, tendons, soft tissues and also nerves located in the surgical access path to the nidus (focus) cannot always be ruled out, CT-guided radiofrequency ablation (RFA; synonyms: thermal ablation; sclerotherapy) of the nidus is now considered standard therapy and is used primarily for involvement of the dorsal (posterior portions) of the spine. In the course of this, a special probe is inserted into the nidus and heated at the tip via an alternating current field.This destroys the prostaglandin-producing cells (prostaglandin = tissue hormone that triggers pain, among other things) in the center and the pain conduction pathways. The procedure is minimally invasive.Another option for heat ablation is laser ablation (LA).
