Management of Giant Cell Tumor of Distal End Radius: Extended Curettage and Adjuvant Therapy vs Wide Resection and Reconstruction: A Systematic Review and Meta-Analysis

Abstract

Abstract Introduction Managing giant cell tumors (GCTs) located in the distal radius poses a considerable challenge, and determining the best surgical approach remains a subject of ongoing discussion. The primary treatment methods involve surgical interventions, specifically extended curettage with adjuvant therapy and wide resection with reconstruction. The objective of this comprehensive systematic review and meta- analysis is to compare functional scores, recurrence risk, metastatic rates, and total complications through these two surgical procedures. Methods We performed a systematic search of the existing literature. Our search encompassed prominent databases such as PubMed, Google Scholar, the Cochrane collaboration, ResearchGate, Scopus, and the New England Journal of Medicine. The primary focus of our inclusion criteria was on studies that offered a comparative evaluation between extended curettage, supplemented with adjuvants, and wide resection coupled with reconstruction in patients diagnosed with GCTs situated in the distal radius. We gathered data concerning the rates of recurrence, metastasis, overall complications, and functional outcomes. Results We included 17 retrospective studies (n = 527 patients). The average age of the participants was 33.49 years (SD ± 2.3), and the average follow-up period was 7.1 years (SD ± 3.7). Patients who underwent curettage were more likely to develop higher recurrence rate (OR = 3.48, 95% CI [2.02, 5.99], p < 0.01) than those who underwent wide resection. Patients who underwent curettage showed a significant reduction in overall complications compared to wide resection complications rate in the curettage group (OR = 0.23, 95% CI [0.13, 0.38], p < 0.01) and a greater improvement in Visual Analog Scale (MD= -1.43, 95% CI [−2.11, −0.74], p < 0.01) and lower Disabilities of the Arm, Shoulder, and Hand scores (MD= -7.49, 95% CI [- 9.62, −5.36], p < 0.01). No significant difference was found regarding metastasis (OR = 1.19, 95% CI [0.25, 5.61], p = 0.83). Patients who underwent curettage were more likely to develop higher recurrence rate (OR = 3.48, 95% CI [2.02, 5.99], p < 0.01) than those who underwent wide resection. Conclusions Concerning the surgical strategy employed for GCTs located in the distal radius, it was observed that curettage, when complemented with adjuvants, exhibited a greater likelihood of recurrence when compared to the approach involving wide resection and subsequent reconstruction. However, it is worth noting that the curettage approach yielded significantly reduced rates of operative complications, lower pain scores, and superior functional outcomes as opposed to the resection method.