Less Is (Usually) More: When Is Amputation Appropriate for Treatment of Extremity Soft Tissue Sarcoma?

Excerpt

Limb-salvage surgery, combining wide excision and radiotherapy, is the standard of treatment for patients with extremity soft tissue sarcoma. In the only randomized study comparing amputation with limb preservation, Rosenberg et al.1 demonstrated that despite slightly higher local recurrence rates, limb salvage was not detrimental to patient survival. This is a common finding in solid tumor biology: organ preservation is not associated with worse overall survival, even though patients often have more local recurrences. Indeed, breast-conservation therapy is preferred over mastectomy and has been proven to be as effective in multiple randomized studies.2 We also see this, for example, in such diverse tumors as laryngeal cancer3 and anorectal melanoma.4 This trend of “less is more” in surgery is well founded and leads to improved patient satisfaction and quality of life (QOL) without compromising quantity of life. …