Oncologic Outcomes After Extra-Articular Resection of Bone and Soft Tissue Sarcomas Involving Major Joints: A Systematic Review

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Background/Objectives: Extra-articular resection (EAR) may be considered for sarcomas involving or extending into joints, but its oncologic outcomes are not well defined. This study evaluated oncologic outcomes following EAR for bone and soft tissue sarcomas of the knee, shoulder, or hip. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in the International Prospective Register of Systematic Reviews (ID: CRD420251140969). PubMed and Embase were searched from inception through 14 January 2026, to identify studies including patients with bone or soft tissue sarcomas involving or extending into the knee, shoulder, or hip joints who underwent EAR. Studies including other types of resections or mixed populations were excluded. Primary outcomes were local recurrence (LR) and distant metastasis (DM); secondary outcomes were 1- and 5-year overall survival (OS). Proportions were estimated using sample size-weighted pooling, with 95% confidence intervals (95% CIs) calculated using the Wilson score method. Exploratory subgroup analyses were performed by anatomic location for LR and histologic subtype for DM. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal Checklist for case series, and the Newcastle–Ottawa Scale for cohort studies. Results: Twenty-one studies, comprising 455 patients, were included. Pooled LR was 11.65% (95% CI, 8.92–15.04), with the highest proportion in the hip (17.65%; 95% CI, 10.53–27.75), followed by the shoulder (10.90%; 95% CI, 6.66–17.13) and knee (9.81%; 95% CI, 6.32–14.80). Pooled DM was 35.26% (95% CI, 30.01–40.87), with the highest proportion in Ewing sarcoma (50.00%; 95% CI, 23.66–76.34) and the lowest in chondrosarcoma (13.79%; 95% CI, 4.51–32.57). No significant differences were found in exploratory subgroup analyses. The 1-year and 5-year OS rates were 92.13% (95% CI, 85.63–95.95) and 58.42% (95% CI, 51.28–65.23), respectively. Conclusions: EAR was associated with low reported LR and moderate survival in patients with sarcomas involving or extending into major joints. DM likely reflects underlying tumor biology. These findings should be interpreted cautiously given the lack of a comparison group, heterogeneity of included studies, and statistical limitations.

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