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Background <p>Limb-sparing surgery has become the preferred surgical approach for primary malignant bone tumors of the extremities, offering oncologic outcomes comparable to amputation while preserving function and quality of life. However, the extent to which patients with potentially resectable disease fail to receive surgical intervention at a population level remains poorly defined. This study aimed to quantify missed opportunities for surgical treatment and to evaluate associated survival outcomes using a large population-based dataset.</p> Methods <p>A retrospective cohort study was conducted using data from the Surveillance, Epidemiology, and End Results (SEER) database (1988–2016). Patients aged 40–74&#xa0;years with primary malignant bone tumors of the extremities were included. Surgical management was categorized as limb-sparing surgery, amputation, or no surgery. Missed surgical opportunity was defined as the absence of any surgical intervention in patients with localized or regional disease. Survival outcomes were assessed using Kaplan–Meier analysis and Cox proportional hazards regression. Logistic regression was used to identify predictors of missed surgical opportunities.</p> Results <p>Among 3323 eligible patients, 51.1% underwent limb-sparing surgery, 10.3% amputation, and 38.6% no surgery. Among patients with localized or regional disease (n = 2520), 723 (28.7%) did not undergo surgery, representing missed surgical opportunities. Kaplan–Meier analysis showed significant survival differences (log-rank p &lt; 0.001). Median survival was not reached for limb-sparing surgery, compared with 56.4 months for amputation and 47.9 months for no surgery. After adjustment, amputation was associated with improved survival versus no surgery (HR 0.68, p = 0.031), while limb-sparing surgery was not significant. No independent predictors of missed surgical opportunities were identified. Among resectable cases, 39.8% did not undergo limb-sparing surgery (amputation or no surgery); however, only those with no surgery were classified as missed surgical opportunities.</p> Conclusion <p>Nearly one-third of patients with potentially resectable extremity bone tumors do not receive surgical intervention, highlighting a substantial and potentially preventable treatment gap. These findings underscore the need for timely diagnosis, referral to specialized centers, and system-level strategies to improve access to appropriate surgical care.</p>

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Modeling Missed Surgical Opportunities in Primary Bone Tumors: A Population-Based Orthopaedic Perspective Using SEER Data

  • 期刊论文

  • 发表日期：

    2026年6月29日

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  • Saquib Jan,
  • B. Rithik Dharan,
  • T. Akash Narayan,
  • Irbaz Ahmad

摘要

Background

Limb-sparing surgery has become the preferred surgical approach for primary malignant bone tumors of the extremities, offering oncologic outcomes comparable to amputation while preserving function and quality of life. However, the extent to which patients with potentially resectable disease fail to receive surgical intervention at a population level remains poorly defined. This study aimed to quantify missed opportunities for surgical treatment and to evaluate associated survival outcomes using a large population-based dataset.

Methods

A retrospective cohort study was conducted using data from the Surveillance, Epidemiology, and End Results (SEER) database (1988–2016). Patients aged 40–74 years with primary malignant bone tumors of the extremities were included. Surgical management was categorized as limb-sparing surgery, amputation, or no surgery. Missed surgical opportunity was defined as the absence of any surgical intervention in patients with localized or regional disease. Survival outcomes were assessed using Kaplan–Meier analysis and Cox proportional hazards regression. Logistic regression was used to identify predictors of missed surgical opportunities.

Results

Among 3323 eligible patients, 51.1% underwent limb-sparing surgery, 10.3% amputation, and 38.6% no surgery. Among patients with localized or regional disease (n = 2520), 723 (28.7%) did not undergo surgery, representing missed surgical opportunities. Kaplan–Meier analysis showed significant survival differences (log-rank p < 0.001). Median survival was not reached for limb-sparing surgery, compared with 56.4 months for amputation and 47.9 months for no surgery. After adjustment, amputation was associated with improved survival versus no surgery (HR 0.68, p = 0.031), while limb-sparing surgery was not significant. No independent predictors of missed surgical opportunities were identified. Among resectable cases, 39.8% did not undergo limb-sparing surgery (amputation or no surgery); however, only those with no surgery were classified as missed surgical opportunities.

Conclusion

Nearly one-third of patients with potentially resectable extremity bone tumors do not receive surgical intervention, highlighting a substantial and potentially preventable treatment gap. These findings underscore the need for timely diagnosis, referral to specialized centers, and system-level strategies to improve access to appropriate surgical care.