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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2018

01-02-2018 | Bone and Soft Tissue Sarcomas

Amputation for Extremity Sarcoma: Contemporary Indications and Outcomes

Authors: Derek J. Erstad, MD, John Ready, MD, John Abraham, MD, Marco L. Ferrone, MD, Monica M. Bertagnolli, MD, Elizabeth H. Baldini, MD, MPH, Chandrajit P. Raut, MD, MSc

Published in: Annals of Surgical Oncology | Issue 2/2018

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Abstract

Introduction

Amputation for localized extremity sarcoma (ES), once the primary therapy, is now rarely performed. We reviewed our experience to determine why patients with sarcoma still undergo immediate or delayed amputation, identify differences based on amputation timing, and evaluate outcomes.

Methods

Records of patients with primary, nonmetastatic ES who underwent amputation at our institution from 2001 to 2011 were reviewed. Univariate analysis was performed, and survival outcomes were calculated.

Results

We categorized 54 patients into three cohorts: primary amputation (A1, n = 18, 33%), secondary amputation after prior limb-sparing surgery (A2, n = 22, 41%), and hand and foot sarcomas (HF, n = 14, 26%). Median age at amputation was 54 years (range 18–88 years). Common indications for amputation (> 40%) were loss of function, bone involvement, multiple compartment involvement, and large tumor size (A1); proximal location, joint involvement, neurovascular compromise, multiple compartment involvement, multifocal or fungating tumor, loss of function, and large tumor size (A2); and joint involvement and prior unplanned surgery (HF). There was no difference in disease-specific survival (DSS) (p = 0.19) or metastasis-free survival (MFS) (p = 0.31) between early (A1) and delayed (A2) amputation. Compared with cohorts A1/A2, HF patients had longer overall survival (OS) (p = 0.04).

Conclusions

Indications for amputation for extremity sarcoma vary between those who undergo primary amputation, delayed amputation, and amputation for hand or foot sarcoma. Amputations chosen judiciously are associated with excellent disease control and survival. For patients who ultimately need amputation, timing (early vs. delayed) does not affect survival.
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Metadata
Title
Amputation for Extremity Sarcoma: Contemporary Indications and Outcomes
Authors
Derek J. Erstad, MD
John Ready, MD
John Abraham, MD
Marco L. Ferrone, MD
Monica M. Bertagnolli, MD
Elizabeth H. Baldini, MD, MPH
Chandrajit P. Raut, MD, MSc
Publication date
01-02-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6240-5

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