Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-11-2014 | Orthopaedic Surgery

Functional outcomes and quality of life in patients with osteosarcoma treated with amputation versus limb-salvage surgery: a systematic review and meta-analysis

Authors: Jiong Mei, Xiao-Zhong Zhu, Zhi-Yuan Wang, Xuan-Song Cai

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 11/2014

Abstract

Introduction

To perform a meta-analysis for comparing the functional outcomes and quality of life (QOL) of osteosarcoma patients receiving amputation or limb-salvage surgeries.

Materials and methods

A search was conducted of the Medline, Cochrane, EMBASE, and Google Scholar on September 30, 2013. Studies were included in the analysis if there were patients who underwent amputation and limb-salvage surgery for osteosarcoma or Ewing’s sarcoma, and for whom postoperative functional outcomes and QOL were evaluated. Outcomes were compared between participants who underwent limb-salvage operation and those who underwent amputation. The methodological quality of non-randomized comparative studies was assessed using the Newcastle–Ottawa Scale.

Results

A total of 121 studies were identified and 6 were included in the meta-analysis. Quality assessment indicated that all six studies were of high quality. The mean age of the participants ranged from 17 to 37 years, and among them 118 underwent amputations and 138 underwent limb-salvage procedures. The mean length of follow-up ranged from 28 to 145 months. The meta-analysis indicated that functional outcomes and QOL were similar between patients who underwent amputation and those who underwent a limb-salvage procedure.

Conclusions

This meta-analysis including six high-quality studies indicates that amputation and limb-salvage surgery provide similar functional outcomes and quality of life for patients with osteosarcomas.

Available only for authorised users

Luetke A, Meyers PA, Lewis I, Juergens H (2014) Osteosarcoma treatment—where do we stand? A state of the art review. Cancer Treat Rev 40:523–532PubMedCrossRef

Bölling T, Hardes J, Dirksen U (2013) Management of bone tumours in paediatric oncology. Clin Oncol (R Coll Radiol) 25:19–26. doi:10.1016/j.clon.2012.07.010 CrossRef

Abed R, Grimer R (2010) Surgical modalities in the treatment of bone sarcoma in children. Cancer Treat Rev 36:342–347. doi:10.1016/j.ctrv.2010.02.010 PubMedCrossRef

Holzer LA, Sevelda F, Fraberger G, Bluder O, Kickinger W, Holzer G (2014) Body image and self-esteem in lower-limb amputees. PLoS One 9:e92943PubMedCrossRefPubMedCentral

Peirano AH, Franz RW (2012) Spirituality and quality of life in limb amputees. Int J Angiol 21:47–52PubMedCrossRefPubMedCentral

Han G, Wang Y, Bi WZ (2012) Study on the health-related quality of life in patients after surgery for malignant bone tumors. Asian Pac J Cancer Prev 13:127–130PubMedCrossRef

Yin K, Liao Q, Zhong D, Ding J, Niu B, Long Q, Ding D (2012) Meta-analysis of limb salvage versus amputation for treating high-grade and localized osteosarcoma in patients with pathological fracture. Exp Ther Med 4:889–894. doi:10.3892/etm.2012.685 PubMedPubMedCentral

Mavrogenis AF, Abati CN, Romagnoli C, Ruggieri P (2012) Similar survival but better function for patients after limb salvage versus amputation for distal tibia osteosarcoma. Clin Orthop Relat Res 470:1735–1748. doi:10.1007/s11999-011-2238-7 PubMedCrossRefPubMedCentral

Ottaviani G, Robert RS, Huh WW, Palla S, Jaffe N (2013) Sociooccupational and physical outcomes more than 20 years after the diagnosis of osteosarcoma in children and adolescents: limb salvage versus amputation. Cancer 119:3727–3736. doi:10.1002/cncr.28277 PubMed

10.

Mason GE, Aung L, Gall S, Meyers PA, Butler R, Krüg S, Kim M, Healey JH, Gorlick R (2013) Quality of life following amputation or limb preservation in patients with lower extremity bone sarcoma. Front Oncol 3:210. doi:10.3389/fonc.2013.00210 PubMedCrossRefPubMedCentral

11.

Malek F, Somerson JS, Mitchel S, Williams RP (2012) Does limb-salvage surgery offer patients better quality of life and functional capacity than amputation? Clin Orthop Relat Res 470:2000–2006PubMedCrossRefPubMedCentral

12.

Eiser C (2009) Assessment of health-related quality of life after bone cancer in young people: easier said than done. Eur J Cancer 45:1744–1747. doi:10.1016/j.ejca.2009.02.025 PubMedCrossRef

13.

Barr RD, Wunder JS (2009) Bone and soft tissue sarcomas are often curable–but at what cost?: a call to arms (and legs). Cancer 115:4046–4054. doi:10.1002/cncr.24458 PubMedCrossRef

14.

Nagarajan R, Clohisy DR, Neglia JP, Yasui Y, Mitby PA, Sklar C, Finklestein JZ, Greenberg M, Reaman GH, Zeltzer L, Robison LL (2004) Function and quality-of-life of survivors of pelvic and lower extremity osteosarcoma and Ewing’s sarcoma: the Childhood Cancer Survivor Study. Br J Cancer 91:1858–1865. doi:10.1038/sj.bjc.6602220 PubMedCrossRefPubMedCentral

15.

Zahlten-Hinguranage A, Bernd L, Ewerbeck V, Sabo D (2004) Equal quality of life after limb-sparing or ablative surgery for lower extremity sarcomas. Br J Cancer 91:1012–1014 (Article in German). doi:10.1038/sj.bjc.6602104

16.

Hawkins AT, Henry AJ, Crandell DM, Nguyen LL (2014) A systematic review of functional and quality of life assessment after major lower extremity amputation. Ann Vasc Surg 28:763–780PubMedCrossRef

17.

Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2014) The Newcastle-Ottawa Scale NOS. for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 13 Jan 2014

18.

Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR (2000) Empirical assessment of effect of publication bias on meta-analyses. BMJ 320:1574–1577PubMedCrossRefPubMedCentral

19.

Davis AM, Devlin M, Griffin AM, Wunder JS, Bell RS (1999) Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: a matched case-control study. Arch Phys Med Rehabil 80:615–618PubMedCrossRef

20.

Bekkering WP, Vliet Vlieland TP, Koopman HM, Schaap GR, Schreuder HW, Beishuizen A, Tissing WJ, Hoogerbrugge PM, Anninga JK, Taminiau AH (2010) Quality of life in young patients after bone tumor surgery around the knee joint and comparison with healthy controls. Pediatr Blood Cancer 54:738–745. doi:10.1002/pbc.22439 PubMed

21.

Renard AJ, Veth RP, Schreuder HW, van Loon CJ, Koops HS, van Horn JR (2000) Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol 73:198–205PubMedCrossRef

22.

Robert RS, Ottaviani G, Huh WW, Palla S, Jaffe N (2010) Psychosocial and functional outcomes in long-term survivors of osteosarcoma: a comparison of limb-salvage surgery and amputation. Pediatr Blood Cancer 54:990–999. doi:10.1002/pbc.22419 PubMedPubMedCentral

23.

Yonemoto T, Ishii T, Takeuchi Y, Kimura K, Hagiwara Y, Tatezaki S (2007) Education and employment in long-term survivors of high-grade osteosarcoma: a Japanese single-center experience. Oncology 72:274–278. doi:10.1159/000113038 PubMedCrossRef

24.

Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246PubMed

25.

Davis AM, Wright JG, Williams JI, Bombardier C, Griffin A, Bell RS (1996) Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual Life Res 5:508–516PubMedCrossRef

26.

Short Form (SF)-36 Health Survey (2014) Available at: http://www.sf-36.org/tools/sf36.shtml. Accessed 13 Jan 2014

27.

Aksnes LH, Bauer HC, Jebsen NL, Follerås G, Allert C, Haugen GS, Hall KS (2008) Limb-sparing surgery preserves more function than amputation: a Scandinavian sarcoma group study of 118 patients. J Bone Joint Surg Br 90:786–794. doi:10.1302/0301-620x.90b6.19805 PubMedCrossRef

28.

Nagarajan R, Neglia JP, Clohisy DR, Robison LL (2002) Limb salvage and amputation in survivors of pediatric lower-extremity bone tumors: what are the long-term implications? J Clin Oncol 20:4493–4501PubMedCrossRef

29.

Eiser C, Darlington AS, Stride CB, Grimer R (2001) Quality of life implications as a consequence of surgery: limb salvage, primary and secondary amputation. Sarcoma 5:189–195. doi:10.1080/13577140120099173 PubMedCrossRefPubMedCentral

30.

Schrager J, Patzer RE, Mink PJ, Ward KC, Goodman M (2011) Survival outcomes of pediatric osteosarcoma and Ewing’s sarcoma: a comparison of surgery type within the SEER database, 1988-2007. J Registry Manag 38:153–161PubMed

Title: Functional outcomes and quality of life in patients with osteosarcoma treated with amputation versus limb-salvage surgery: a systematic review and meta-analysis
Authors: Jiong Mei
Xiao-Zhong Zhu
Zhi-Yuan Wang
Xuan-Song Cai
Publication date: 01-11-2014
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 11/2014
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-014-2086-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Functional outcomes and quality of life in patients with osteosarcoma treated with amputation versus limb-salvage surgery: a systematic review and meta-analysis

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2014

ACL injuries and stem cell therapy

Novel endoscopic sacroiliac screw removal technique: reduction of intraoperative radiation exposure

Locked tension band wiring using ring pins for patellar fractures: a method of minimising implant migration

Midterm functional outcome after dorsal capsular imbrication for posttraumatic instability of the distal radioulnar joint

Complications after arthroscopic knee surgery

Arthroscopic reduction and acetabuloplasty for the treatment of dislocated hips in children of walking age: a preliminary report