Surgical treatment of clavicular malignancies

Hypothesis

Primary and metastatic malignancies of the clavicle are very rare, and little literature is available regarding the long-term functional and oncologic outcome after surgical treatment. To what advantage or disadvantages clavicle reconstruction following claviculectomy will lead is not clear. The hypothesis is that there is no advantage of allograft reconstruction over no reconstruction in terms of the functional outcome and complications.

Materials and methods

From 1999 to 2009, 11 patients with clavicular malignancy underwent total or subtotal claviculectomy with or without allograft reconstruction. Oncologic and functional results were assessed.

Results

The average age at time of operation was 31.9 years. The mean follow-up time was 42.4 months. Six patients had allograft reconstruction after tumor resection, and 5 had claviculectomy alone. No local recurrence occurred. The oncologic result was continuous disease-free in 5 patients, no evidence of disease in 1, alive with disease in 2, and died of disease in 3. Patients with and without allograft reconstruction had average Musculoskeletal Tumor Society score of 92.2% vs 96.2% and Constant-Murley scores of 84.8 vs 88.8. Patients with allograft reconstruction had more complications than patients without reconstruction.

Discussion

Considering complications, allograft reconstruction does not guarantee a satisfied patient. Total or subtotal excisions of the clavicle without reconstruction for malignancies are rarely associated with a clinically significant loss of function. Furthermore, the average time of full use of upper limb was slower in patients with reconstruction compared with those without reconstruction.

Conclusions

Clavicular malignancies had poor prognosis, although claviculectomy could provide good local tumor control. Allograft reconstruction after claviculectomy was not justified for malignancies in terms of its functional outcomes as well as complications.

Level of evidence: Level IV, Case Series, Treatment Study

Keywords: Clavicle, malignancy, claviculectomy, allograft