Functional outcome of scapulectomy in children - single-center experience and systematic review of the literature.

BACKGROUND

Recent advances in reconstruction of the shoulder girdle and scapula had a significant impact on functional outcome in adults who underwent oncologic scapulectomy. In children and adolescents, scapula tumors are rare. Moreover, the growing skeleton and high functional demands in this age group may hinder transferability of the promising results achieved in adults. This study aims to explore the functional outcome and different reconstructive options used in children undergoing (partial) scapulectomy.

METHODS

A single-center retrospective analysis of scapula tumors in children was performed. Furthermore, a systematic review and synthesis of qualitative and quantitative studies were conducted to investigate the functional outcome of children and adolescents undergoing Malawer II or Malawer III resection.

RESULTS

In total, 3 patients were deemed eligible for the single-center retrospective analysis. The 3 children (2 boys, 1 girl, aged 4 - 11 years) all had Ewing sarcoma of the scapula. Two patients underwent Malawer II resection and had a better functional outcome than the 1 child that underwent Malawer III resection. Concerning the systematic review, of the 714 initial search results, 17 studies were eligible for inclusion. In total, 47 patients were extracted from the 17 studies. The analysis showed that patients who underwent Malawer III resection had a significantly better functional outcome if a reconstructive surgery was performed. Patients who underwent glenoid-preserving Malawer II resection showed similar results with or without reconstruction.

CONCLUSION

Children and adolescents undergoing Malawer III resection benefit from a reconstructive procedure other than humeral suspension. Reconstruction using either endoprosthesis or extracorporeal irradiation and reimplantation provide similar functional outcome after Malawer III resection. In Malawer II resection, reconstructive procedures do not influence functional outcome.