Limb Salvage and Amputation in Survivors of Pediatric Lower-Extremity Bone Tumors: What Are the Long-Term Implications?

Abstract

The past four decades have seen tremendous progress in the treatment of pediatric and adolescent cancers. As a consequence, there are increasing numbers of adult childhood cancer survivors. This has prompted investigation into the long-term consequences of cancer treatments. One group that merits special study is the survivors of lower-extremity bone tumors. Their function and quality of life may depend in part on both the surgery and the age at which it was performed. Comparisons between studies are difficult because small numbers of patients and the use of varying research designs and methods have limited research in this area. The purpose of this article is to review the major surgical approaches to lower-limb bone tumors and their impact on pediatric patients. The results show that survival is equivalent between amputation and limb salvage. Complications occur more frequently in limb salvage. The long-term outcomes of those undergoing amputation and limb salvage have not been found to be substantially different in regard to quality of life. In conclusion, prospective long-term follow-up of pediatric patients with lower-limb tumors is needed to (1) determine in a uniform manner the long-term complications, quality of life, and functionality of this population and describe differences within this patient population based on age at diagnosis and surgical procedure, (2) identify areas of concern that are amenable to intervention, and (3) provide clinicians and future patients a better understanding of the surgical options.

Does Limb-salvage Surgery Offer Patients Better Quality of Life and Functional Capacity than Amputation?

“…Sixth, the ability to compare functional ability and quality of life in different age categories is unclear. Some experts believe pediatric patient populations adapt to amputation better and will have different functionality and psychological response [24]; however, we did not have enough pediatric patients to make such a comparison. A minimum age of 15 years was set to allow for inclusion of more patients in their second decade of life-a frequently affected age group-while removing prepubescent and skeletally immature patients from analysis owing to the emotional and physical differences in these patients.…”

Treatment of patients with "high grade" extremity localized chondrosarcoma. Preliminary results

“…4,5 There are very few published data on the survival, efficacy and role of chemotherapy of high-grade chondrosarcoma patients. 6,7 Lately, some authors separate a high-grade chondrosarcoma as a special diagnostic and treatment problem. 10 Introducing protocols with a neo-adjuvant chemotherapy should improve survival rates in patients with high-grade chondrosarcoma.…”

“…3,6 Chemo and radiotherapy have low impact on the final outcome. The radical surgical resection of chondrosarcoma is primary treatment.…”

“…There are very few published data on the survival, efficacy and role of chemotherapy of high-grade chondrosarcoma patients. 6,7 This facts were the motives for this study, and the aim was to analyse the chemotherapy protocol and various limb-salvage surgical techniques in correlation to survival of patients and function of spared limbs.…”

Quality of Life (QOL) in Long-Term Survivors of Osteosarcoma

“…On the other hand, orthopedic surgeons confront challenging problems related to limb-salvage surgery such as complications associated with the delayed chemotherapy (secondary malignancy or infertility) and postoperative complications such as infection and the mechanical failure or instability of the metal prosthesis [7][8][9]. Many studies have reported on the functional status of the extremities on the affected side in long-term survivors from osteosarcoma [10][11][12][13], however, there are insufficient about the quality of life [14][15][16][17][18][19][20]. So we conducted this study to evaluate the quality of life in longterm survivors from osteosarcoma.…”