Recycled autografts are widely used in limb salvage surgery for patients with long-bone defects due to bone sarcoma resection. Currently, there are limited number of studies to sufficiently estimate graft survival and its modes of failure. We aim to assess the survival probability of recycled autografts and its associated prognostic factors in limb salvage surgery of long-bone sarcoma. We performed a systematic search from PubMed, Embase and Scopus. Observational studies and case series reporting graft survival outcomes with follow-up data were included. Graft survival probabilities at 1, 2, 5, and 10 years were pooled. Using data of individual participant data (IPD), prognostic factors associated with poor graft survival and mean survival time for the recycled autograft were identified using multivariable flexible parametric regression. A total of 2388 articles were identified. Twenty-eight studies with 395 patients were eligible. The median age of the patients was 20 years (interquartile range, 15–34) and approximately half of them were male. From study-level meta-analysis, the pooled graft 5-year survival probability of the recycled autograft was 91.0% (95%CI 85.4–95.6; I2 49.6%; very low certainty of evidence). From IPD analysis, male gender, femur and tibia osteoarticular resections were significantly associated with poor graft survival rates comparing to intercalary resection. Furthermore, infection ranked the most observed cause among all failures. The recycled autograft may offer a feasible limb-salvage option for long-bone sarcomas. With individual participant data, our results suggest factors that associated with poor graft survival. However, further prospective studies with large sample size focusing on graft survival would be needed.
Klangjorhor et al. (Sun,) studied this question.