Surgical treatment of soft tissue tumors with locally invasive growth pattern or sarcomas posterior to the clavicle

Objective To investigate the feasibility and safety of trans-clavicle approach for resection of neck tumors posterior to clavicle. Methods The clinical characteristics, imaging features, pathological findings and treatment modalities were retrospectively collected from the prospective database of Fudan University Shanghai Cancer Center from January 2014 to January 2017. Twelve patients(7 males and 5 females) were enrolled in the study, aged from 18 to 74 years. There were 4 myxofibrosarcomas, 4 desmoid fibrosis, 2 myofibroblastic tumors, 1 extraesseous osteosarcoma and 1 high grade spindle cell sarcoma. The tumor had a long diameter of 4 to 12 cm (median value is 8 cm). All patients underwent clavicle incision, soft tissue tumor resection and clavicular reduction plate internal fixation. The split position of clavicle was in midshaft 1/3. The triangular towel was fixed for 4-6 weeks after operation. Postoperative complications were evaluated by T94 grading system, and postoperative function was evaluated by musculoskeletal tumor score(MSTS). Results All the tumors were resected completely by en bloc with R0 margin in 10 cases, R1 in 2 cases.There were no severe surgical complications.the median follow-up was 24 months(12-38 months). The average MSTS of limb function was 28 before operation, and the average MSTC of limb function was 28 at 6 months after operation. Local recurrence occurred in 2 cases (recurrence of 2 months and 3 months after surgery), including 1 case of extra-osseous osteosarcoma, recurrence with brain metastasis, died 20 months after surgery. Conclusions The clavicle incision can be safely applied to the soft tissue invasive neoplasms and sarcoma resection behind the clavicle, with good postoperative limb function and satisfactory tumor control. Key words: Soft tissue neoplasms; Surgical procedures, operative; Postoperative complications; Trans-clavicle approach