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Major Amputations for Extremity Soft-Tissue Sarcoma.

Henry G Smith1, Joseph M Thomas1, Myles J F Smith1

  • 1The Sarcoma Unit, Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK.

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|May 27, 2017
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Summary
This summary is machine-generated.

Major amputation for extremity soft-tissue sarcoma (ESTS) remains crucial for select cases, offering durable local control. However, outcomes are poorer compared to limb-sparing surgery, especially in metastatic disease.

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Area of Science:

  • Orthopedic Oncology
  • Surgical Oncology
  • Sarcoma Research

Background:

  • Limb-sparing surgery is now common for extremity soft-tissue sarcoma (ESTS).
  • Major amputation for ESTS is therefore infrequent.
  • This study evaluates indications and outcomes of major amputation for ESTS.

Purpose of the Study:

  • To determine the indications for major amputation in ESTS.
  • To assess oncological outcomes following major amputation for ESTS.
  • To evaluate if amputation is prognostic for oncological outcomes in primary ESTS.

Main Methods:

  • Retrospective review of patients undergoing major amputation for ESTS between 2004 and 2014.
  • Analysis of amputation rates, recurrence rates, and survival.
  • Comparison of outcomes between amputation and limb-conserving surgery for primary localized disease.

Main Results:

  • Amputation rate for primary localized ESTS was 4.1%.
  • Of 69 patients, 33.3% had primary disease, 52.2% recurrent, and 14.5% metastatic.
  • Three-year overall survival was 50.3% for curative amputation; median survival was 6 months for palliative amputation.
  • Amputation for primary disease was associated with higher grade, larger tumors, and poorer systemic relapse rates compared to limb conservation.
  • Amputation was only prognostic for overall survival.

Conclusions:

  • Amputation remains vital for ESTS management, particularly for patients unsuitable for limb-sparing surgery.
  • Durable local control can be achieved with amputation in select ESTS cases.
  • Amputation for metastatic ESTS yields poor survival and should be reserved for palliative care.