Amputation for Extremity Sarcoma: Indications and Outcomes. 2021

Maya Kirilova, and Alexander Klein, and Lars H Lindner, and Silke Nachbichler, and Thomas Knösel, and Christof Birkenmaier, and Andrea Baur-Melnyk, and Hans Roland Dürr
Musculoskeletal Oncology, Department of Orthopaedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-University Munich, D-81377 Munich, Germany.

BACKGROUND Sarcomas are rare, malignant tumors of soft tissues or bone. Limb salvage surgery (LSS) is the standard treatment, but amputation is still an option, especially in local recurrence or complications after LSS. METHODS We retrospectively reviewed indications and oncological outcomes in patients who underwent an amputation. Two groups with either primary amputations (n = 120) or with secondary amputations after failed LSS with local recurrence or complications (n = 29) were compared with the main end points of LRFS and OS. RESULTS Five-year LRFS was 84% with 17 (16%) patients developing local recurrence, of which 16 (13%) occurred in group I. Forty-two (28%) patients developed metastatic disease and overall survival at five years was 44%. Overall survival (OS) was the same in both groups. In those group II patients who had a secondary amputation due to LR or insufficient margins after LSS (n = 12) the five-year OS was 33% compared to 48% in patients with amputation due to complications (n = 17) (n.s.). CONCLUSIONS This study indicates the worse oncological outcomes with respect to OS of sarcoma patients requiring an amputation as compared to LSS. Patients with primary amputation or those who had a secondary amputation after failed LSS for whatever reason showed the same oncological results.

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