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. 2021 Oct 13;13(20):5125.
doi: 10.3390/cancers13205125.

Amputation for Extremity Sarcoma: Indications and Outcomes

Maya Kirilova  1   2 , Alexander Klein  1   2 , Lars H Lindner  2   3 , Silke Nachbichler  2   4 , Thomas Knösel  2   5 , Christof Birkenmaier  1   2 , Andrea Baur-Melnyk  2   6 , Hans Roland Dürr  1   2
Affiliations

Amputation for Extremity Sarcoma: Indications and Outcomes

Maya Kirilova et al. Cancers (Basel). .

Abstract

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.

Keywords: amputation; local recurrence; prognosis; sarcoma; surgery; survival.

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Conflict of interest statement

All authors have no financial and personal relationships with other people or organizations that could inappropriately influence (bias) this work.

Figures

Figure 1
Figure 1
Axial MRI of an Undifferentiated Pleomorphic Sarcoma of the right lower leg infiltrating the bone (*) and the major vessels and nerves (→).
Figure 2
Figure 2
Radiographs and axial MRI of a patient with an osteosarcoma. After pathological fracture an osteosynthesis has induced widespread contamination and tumor growth of the whole distal upper calf.
Figure 3
Figure 3
More than 30 years after treatment of a Ewing sarcoma of the humerus with local radiation and chemotherapy complications such as chronic osteomyelitis, nerve palsy and edema, an amputation due to functional reasons was indicated.
Figure 4
Figure 4
Overall survival (OS) in 146 patients with primary or secondary amputations (three patients excluded due to insufficient data), n.s.
Figure 5
Figure 5
Local recurrence-free survival (LRFS) in 144 patients with primary or secondary amputations (five patients excluded due to insufficient data), n.s.
Figure 6
Figure 6
Overall survival by local recurrence after amputation, n = 143, six patients excluded due to insufficient data, n.s. (p = 0.0642).
Figure 7
Figure 7
Overall survival by local recurrence before amputation, n = 139, 10 patients excluded due to insufficient data, n.s. (p = 0.0625).
See this image and copyright information in PMC

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