Long-term oncological and functional outcomes in patients with bone sarcomas in the proximal femur undergoing unplanned surgery: A single-center retrospective cohort study.

Background: The clinical and radiological presentation of bone sarcomas in the proximal femur is often atypical, frequently leading to diagnostic errors or inappropriate treatments. To our knowledge, no previous studies have analyzed reasons for or compared outcomes among patients with proximal femoral bone sarcomas undergoing unplanned surgery. Methods: Patients with proximal femoral bone sarcomas treated at our institution between January 2013 and January 2023 were retrospectively reviewed, including those initially misdiagnosed or mismanaged. Overall survival (OS) and event-free survival (EFS) rates were analyzed using Kaplan-Meier curves and log-rank tests. Independent-samples and paired t-tests were used to compare Musculoskeletal Tumor Society (MSTS) scores, while chi-square tests were used to assess local recurrence rates (LRR). Results: Of the 85 patients included, 27 cases underwent unplanned surgery at external hospitals, including 16 males and 11 females, with a median age of 44 years (range: 11-81 years). Initial preoperative radiologic findings in these patients undergoing unplanned surgery showed no periosteal reaction or soft tissue mass. No significant differences in OS, EFS, or LRR were observed between the unplanned and planned surgery groups (p > 0.05). However, MSTS scores were significantly lower in the unplanned surgery group (p < 0.001). Conclusion: Unplanned surgery correlates with poorer functional outcomes. Reducing its incidence requires not only improved diagnostic imaging but also increased clinical suspicion, adherence to standardized diagnostic protocols, and early referral to specialized sarcoma centers. A multidisciplinary approach by experienced teams may enhance diagnostic accuracy and surgical planning, thereby minimizing unplanned interventions.