{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T08:54:50Z","timestamp":1760864090823,"version":"3.44.0"},"reference-count":28,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T00:00:00Z","timestamp":1593561600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,6,28]]},"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:p>A 17-year-old man with osteosarcoma of the proximal humerus was planned for possible limb salvage surgery after standard neoadjuvant chemotherapy. However, during the surgical phase of treatment, the COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak occurred changing the healthcare landscape due to uncertainty regarding the virus, risk of COVID-19 infection and complications, and implementation of an enhanced community quarantine restricting movement of people within cities. Instead of limb salvage surgery, the patient underwent a forequarter amputation. Exposure to the virus in a high-risk hospital setting was minimised with patient discharge after a short hospital stay and home convalescence monitored by video conferencing. Multidisciplinary sarcoma team meetings with family members and a sarcoma navigator nurse were crucial in managing expectations and deciding on appropriate treatment in the setting of a novel infectious disease causing a pandemic.<\/jats:p>","DOI":"10.1136\/bcr-2020-237197","type":"journal-article","created":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T02:12:53Z","timestamp":1594260773000},"page":"e237197","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Radical change in osteosarcoma surgical plan due to COVID-19 pandemic"],"prefix":"10.1136","volume":"13","author":[{"given":"Czar Louie Lopez","family":"Gaston","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Quirino Memorial Medical Center, Quezon City, Philippines"},{"name":"Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johann Proceso","family":"Pag-ong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Quirino Memorial Medical Center, Quezon City, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilleo","family":"Dacanay","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert Jerome","family":"Quintos","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,7,8]]},"reference":[{"key":"2025082723282671000_13.7.e237197.1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.59.4895"},{"key":"2025082723282671000_13.7.e237197.2","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1002\/cncr.30411","article-title":"Results of a randomized, prospective clinical trial evaluating metronomic chemotherapy in nonmetastatic patients with high-grade, operable osteosarcomas of the extremities: a report from the Latin American group of osteosarcoma treatment","volume":"123","author":"Senerchia","year":"2017","journal-title":"Cancer"},{"key":"2025082723282671000_13.7.e237197.3","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1007\/s00268-016-3500-7","article-title":"Amputation versus Limb-Salvage surgery in patients with osteosarcoma: a meta-analysis","volume":"40","author":"Han","year":"2016","journal-title":"World J Surg"},{"key":"2025082723282671000_13.7.e237197.4","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1002\/cncr.27816","article-title":"Pediatric sarcoma in central America: outcomes, challenges, and plans for improvement","volume":"119","author":"Friedrich","year":"2013","journal-title":"Cancer"},{"key":"2025082723282671000_13.7.e237197.5","first-page":"175","article-title":"Clinical outcome and survival of osteosarcoma patients in Cipto Mangunkusumo Hospital: limb salvage surgery versus amputation","volume":"48","author":"Kamal","year":"2016","journal-title":"Acta Med Indones"},{"key":"2025082723282671000_13.7.e237197.6","unstructured":"WHO . Coronavirus disease (COVID-19) situation report 3. Philippines 12 March 2020. Available: https:\/\/www.who.int\/docs\/default-source\/wpro-documents\/countries\/philippines\/emergencies\/covid-19\/who-phl-sitrep-3-covid-19-12mar2020.pdf; [Accessed 22 May 2020]."},{"key":"2025082723282671000_13.7.e237197.7","unstructured":"WHO . Coronavirus disease (COVID-19) situation report 4. Philippines 14 March 2020. Available: https:\/\/www.who.int\/docs\/default-source\/wpro-documents\/countries\/philippines\/emergencies\/covid-19\/who-phl-sitrep-4-covid-19-14mar2020.pdf; [Accessed 22 May 2020]."},{"key":"2025082723282671000_13.7.e237197.8","unstructured":"Department of Health Interim Guidelines on COVID-19 Referral Hospitals . Philippines 23 March 2020. Available: https:\/\/www.doh.gov.ph\/sites\/default\/files\/health-update\/dm2020-0142.pdf; [Accessed 22 May 2020]."},{"key":"2025082723282671000_13.7.e237197.9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S0030-5898(20)31629-1","article-title":"Tumors of the shoulder girdle. technique of resection and description of a surgical classification","volume":"22","author":"Malawer","year":"1991","journal-title":"Orthop Clin North Am"},{"key":"2025082723282671000_13.7.e237197.10","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1001\/jama.2020.2565","article-title":"Presumed asymptomatic carrier transmission of COVID-19","volume":"323","author":"Bai","year":"2020","journal-title":"JAMA"},{"key":"2025082723282671000_13.7.e237197.11","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30096-6"},{"key":"2025082723282671000_13.7.e237197.12","article-title":"SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China","volume":"25","author":"Yu","year":"2020","journal-title":"JAMA Oncol"},{"key":"2025082723282671000_13.7.e237197.13","doi-asserted-by":"crossref","first-page":"569","DOI":"10.31557\/APJCP.2020.21.3.569","article-title":"Cancer Care Delivery Challenges Amidst Coronavirus Disease - 19 (COVID-19) Outbreak: Specific Precautions for Cancer Patients and Cancer Care Providers to Prevent Spread","volume":"21","author":"Shankar","year":"2020","journal-title":"Asian Pac J Cancer Prev"},{"key":"2025082723282671000_13.7.e237197.14","doi-asserted-by":"crossref","DOI":"10.1016\/S1470-2045(20)30149-2","article-title":"Risk of COVID-19 for patients with cancer","volume":"21","author":"Wang","year":"2020","journal-title":"Lancet Oncol"},{"key":"2025082723282671000_13.7.e237197.15","doi-asserted-by":"crossref","first-page":"e936","DOI":"10.1634\/theoncologist.2020-0213","article-title":"A practical approach to the management of cancer patients during the novel coronavirus disease 2019 (COVID-19) pandemic: an international Collaborative group","volume":"25","author":"Al-Shamsi","year":"2020","journal-title":"Oncologist"},{"key":"2025082723282671000_13.7.e237197.16","doi-asserted-by":"crossref","first-page":"rjaa131","DOI":"10.1093\/jscr\/rjaa131","article-title":"Preventing spread of SARS-CoV-2 and preparing for the COVID-19 outbreak in the surgical department: perspectives from two Scandinavian countries","volume":"2020","author":"Lindeman","year":"2020","journal-title":"J Surg Case Rep"},{"key":"2025082723282671000_13.7.e237197.17","doi-asserted-by":"crossref","DOI":"10.1016\/j.oraloncology.2020.104734","article-title":"Emergency changes in international guidelines on treatment for head and neck cancer patients during the COVID-19 pandemic","volume":"107","author":"Chaves","year":"2020","journal-title":"Oral Oncol"},{"key":"2025082723282671000_13.7.e237197.18","doi-asserted-by":"crossref","unstructured":"Penel N , Bonvalot S , Minard V , et al . French sarcoma group proposals for management of sarcoma patients during the COVID-19 outbreak. Ann Oncol 2020;9.","DOI":"10.1016\/j.annonc.2020.03.308"},{"key":"2025082723282671000_13.7.e237197.19","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/j.ejso.2020.04.027","article-title":"Surgical management of bone and soft tissue sarcomas and skeletal metastases during the COVID-19 pandemic","volume":"46","author":"Cardoso","year":"2020","journal-title":"Eur J Surg Oncol"},{"key":"2025082723282671000_13.7.e237197.20","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s11751-013-0172-9","article-title":"Proximal humeral reconstruction using nail cement spacer in primary and metastatic tumours of proximal humerus","volume":"8","author":"Kundu","year":"2013","journal-title":"Strategies Trauma Limb Reconstr"},{"key":"2025082723282671000_13.7.e237197.21","doi-asserted-by":"crossref","first-page":"230949901771393","DOI":"10.1177\/2309499017713937","article-title":"Endoprosthetic replacement versus cement spacer in reconstruction of proximal humerus after tumor resection: cost and benefits","volume":"25","author":"Rafalla","year":"2017","journal-title":"J Orthop Surg"},{"key":"2025082723282671000_13.7.e237197.22","first-page":"30122","article-title":"Nosocomial infection with SARS-Cov-2 within departments of digestive surgery","volume":"Apr 27:S1878-7886","author":"Luong-Nguyen","year":"2020","journal-title":"J Visc Surg"},{"key":"2025082723282671000_13.7.e237197.23","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s11596-020-2176-2","article-title":"Clinical and Transmission Characteristics of Covid-19 - A Retrospective Study of 25 Cases from a Single Thoracic Surgery Department","volume":"40","author":"Li","year":"2020","journal-title":"Curr Med Sci"},{"key":"2025082723282671000_13.7.e237197.24","doi-asserted-by":"crossref","first-page":"436","DOI":"10.5435\/JAAOS-D-20-00360","article-title":"Orthopaedic surgical selection and inpatient paradigms during the coronavirus (COVID-19) pandemic","volume":"28","author":"Massey","year":"2020","journal-title":"J Am Acad Orthop Surg"},{"key":"2025082723282671000_13.7.e237197.25","doi-asserted-by":"crossref","DOI":"10.1016\/j.oraloncology.2020.104684","article-title":"Head and neck oncology during the COVID-19 pandemic: reconsidering traditional treatment paradigms in light of new surgical and other multilevel risks","volume":"105","author":"Day","year":"2020","journal-title":"Oral Oncol"},{"key":"2025082723282671000_13.7.e237197.26","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0210775","article-title":"Limiting factors for wearing personal protective equipment (PPE) in a health care environment evaluated in a randomised study","volume":"14","author":"Loibner","year":"2019","journal-title":"PLoS One"},{"key":"2025082723282671000_13.7.e237197.27","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.resuscitation.2006.11.011","article-title":"Personal protection equipment for biological hazards: does it affect tracheal intubation performance?","volume":"74","author":"Greenland","year":"2007","journal-title":"Resuscitation"},{"key":"2025082723282671000_13.7.e237197.28","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.1007\/s00167-020-06022-4","article-title":"COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon","volume":"28","author":"Hirschmann","year":"2020","journal-title":"Knee Surg Sports Traumatol Arthrosc"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-237197","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:28:35Z","timestamp":1756362515000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-237197"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7]]},"references-count":28,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,7,8]]},"published-print":{"date-parts":[[2020,7]]}},"alternative-id":["10.1136\/bcr-2020-237197"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-237197","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,7]]}}}