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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2005

01-01-2005 | Original Article

The Indications for and the Prognostic Significance of Amputation as the Primary Surgical Procedure for Localized Soft Tissue Sarcoma of the Extremity

Authors: Michelle A. Ghert, MD, FRCSC, Adesegun Abudu, MSc, FRCSC, Natasha Driver, Aileen M. Davis, PhD, Anthony M. Griffin, BSc, Dawn Pearce, MD, FRCPC, Lawrence White, MD, FRCPC, Brian O’Sullivan, MD, FRCPC, Charles N. Catton, MD, FRCPC, Robert S. Bell, MD, MSc, FRCSC, Jay S. Wunder, MD, MSc, FRCSC

Published in: Annals of Surgical Oncology | Issue 1/2005

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Abstract

Background

The indications for primary amputation of a localized soft tissue sarcoma (STS) of the extremity are not well defined in the literature. However, it has been suggested that patients who require an amputation to treat an STS are at increased risk for developing metastases. We categorized the main indications for primary amputation in our patient population and compared their oncological outcome with the outcome of patients who underwent limb-sparing surgery.

Methods

413 consecutive patients treated surgically at a single center for primary, nonmetastatic, deep, intermediate-, or high-grade STS of the extremity were reviewed. Indications for primary amputation were identified. Demographics and outcomes were compared between the amputation and limb-salvage groups. Multivariate Cox model analysis was used to identify independent risk factors for systemic relapse.

Results

Twenty-five (6%) of 413 patients with STS underwent primary amputation: they were older (P = .05), had larger tumors (P = .001), and had a significantly greater risk of developing metastatic disease than patients who underwent limb-sparing procedures (P = .008). However, multivariate analysis demonstrated that the only independent predictors of systemic relapse were tumor size (P = .0001) and tumor grade (P = .0001). Primary amputation was not an independent risk factor for metastatic disease.

Conclusions

The decision to perform a primary amputation for an STS of the extremity is based on the location and local extent of the tumor, and the expected function of the extremity after tumor resection. The higher risk of metastases for patients who require primary amputation is accounted for by independent risk factors associated with their tumors—predominantly large tumor size.
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Metadata
Title
The Indications for and the Prognostic Significance of Amputation as the Primary Surgical Procedure for Localized Soft Tissue Sarcoma of the Extremity
Authors
Michelle A. Ghert, MD, FRCSC
Adesegun Abudu, MSc, FRCSC
Natasha Driver
Aileen M. Davis, PhD
Anthony M. Griffin, BSc
Dawn Pearce, MD, FRCPC
Lawrence White, MD, FRCPC
Brian O’Sullivan, MD, FRCPC
Charles N. Catton, MD, FRCPC
Robert S. Bell, MD, MSc, FRCSC
Jay S. Wunder, MD, MSc, FRCSC
Publication date
01-01-2005
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 1/2005
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1007/s10434-004-1171-3

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