Outcomes of surgery for giant cell tumors of the tendon sheath within the hand.

Abstract

<b>Introduction:</b> Giant cell tumor of the tendon sheath is the most common benign proliferative lesion involving the upper limb, characterized by relatively high recurrence rate after surgery. <br><b>Aim:</b> The objective of the study was a retrospective analysis of outcomes of the operative treatment of these tumors, in a longterm (a mean of 4,2 year) follow-up. <br><b>Material and methods:</b> Preoperative examination was performed in 58 patients, 36 females (62%) and 22 males (38%), in a mean age of 41 years, and treatment outcomes were assessed in 47 persons (81% of the operated patients), at a mean of 4.2-year follow-up. The final assessment was performed in a form of phone interview. <br><b>Results:</b> The most common site of the tumors was the fingers - 42 cases (72%). In 31 patients (53%) the lesion had a well-defined capsule, and in 11 (19%) a satellite nodule was found around the main tumor. A total of 9 relapses (21%) occurred, all within the first 2 years following surgery. Two patients had a next episode of recurrence after the second operation. In 8 out of the 9 patients with a recurrence, the primary lesion did not have a well-defined capsule. In 38 patients who had no relapse, 31 were completely symptom-free, whereas 7 complained of mild pain of the scar and/or numbness of a part of the involved finger. <br><b>Conclusions:</b> The main factor that impacted the high rate of recurrence was incomplete tumor excision, which resulted from inadequately accurate surgery and the tumor morphology (having no well-defend capsule). The role of operating with the use of magnifying devices and keeping a greater surgical margin at resection of the non-capsulated lesions was emphasized, as it could translate into reducing the recurrence rate.