Fibulectomy for primary fibular tumors A Decade of experience at the National Cancer Institute, Egypt

Abstract

Primary fibular tumors, whether benign or malignant, are uncommon and include entities such as osteochondroma, giant cell tumor, aneurysmal bone cyst, Ewing sarcoma, and osteosarcoma. Optimal management depends on careful radiological assessment to guide precise surgical planning and achieve adequate oncological outcomes. This study assessed surgical technique with post-treatment sequelea and survival analysis for fibular tumors. This retrospective study analyzed 22 patients with primary fibular tumors who underwent surgical resection at the National Cancer Institute, Cairo University, Egypt, between January 2013 and January 2023, evaluating clinical characteristics, treatment modalities, surgical techniques, postoperative sequelae, and survival outcomes. All patients presented with leg swelling, and the proximal fibula was the most frequently involved site (81.8%), followed by the distal fibula and diaphysis (each 9.1%). Osteosarcoma was the most common histopathological diagnosis (40.9%), followed by Ewing sarcoma (27.3%), giant cell tumor (22.7%), and chondrosarcoma (9.1%). Neoadjuvant therapy was administered in 68.2% of cases. Surgical management included proximal fibulectomy in 36.4% of patients, segmental resection in 27.3%, and above-knee amputation in 13.6%, with preservation of the common peroneal nerve achieved in 68.2% of patients. With a median follow-up of 32 months, the overall recurrence rate was 50%, including 22.7% among osteosarcoma cases. Overall survival rates at one, two, and three years were 94.4%, 75.4%, and 50.2%, respectively, while event-free survival rates at one, two, and three years were 79.4%, 56.3%, and 42.9%. The fibula presents unique surgical challenges due to its anatomical relationship with critical neurovascular structures, particularly the common peroneal nerve, and its contribution to knee and ankle stability; therefore, meticulous preoperative planning and appropriate surgical techniques are essential to achieve safe tumor res