Limb-sparing surgery preserves more function than amputation

Abstract

We evaluated the long-term functional outcome in 118 patients treated for osteosarcoma or Ewing's sarcoma in the extremities a minimum of five years after treatment. We also examined if impaired function influenced their quality of life and ability to work. The function was evaluated according to the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS). Quality of life was assessed by using the Short Form-36 (SF-36). The mean age at follow-up was 31 years (15 to 57) and the mean follow-up was for 13 years (6 to 22). A total of 67 patients (57%) initially had limb-sparing surgery, but four had a secondary amputation. The median MSTS score was 70% (17% to 100%) and the median TESS was 89% (43% to 100%). The amputees had a significantly lower MSTS score than those with limb-sparing surgery (p < 0.001), but there was no difference for the TESS. Tumour localisation above knee level resulted in significantly lower MSTS scores and TESS (p = 0.003 and p = 0.02, respectively). There were no significant differences in quality of life between amputees and those with limb-sparing surgery except in physical functioning. Of the patients 11% (13) did not work or study. In multivariate analysis, amputation, tumour location above the knee and having muscular pain were associated with low physical function. We conclude that most of the bone tumour survivors managed well after adjustment to their physical limitations. A total of 105 are able to work and have an overall good quality of life.

A meta-analysis of randomized control trials of surgical methods with osteosarcoma outcomes

“…We found that the LSS is better than amputation in functional outcomes, which are consistent with other studies [26, 27]. Johansen et al [28] had reported notably higher functional scores after LSS compared with amputation respectively ( P  = 0.001).…”

Effects of metaphyseal bone tumor removal with preservation of the epiphysis and knee arthroplasty

“…3C and D). In accordance with the results from the present study, previous studies have demonstrated that the functional outcomes of epiphysis preservation surgery are similar to those of other limb-saving techniques (22,23). …”

Identifying the Prevalence, Trajectory, and Determinants of Psychological Distress in Extremity Sarcoma

“…The Toronto Extremity Salvage Score (TESS) is an extremity-tumour-specific self-report measure of disability secondary to activity limitation [10]. Ease of completion of 29-30 everyday activities is assessed via a 5-point Likert scale with the option of indicating whether the specific task is not applicable to the respondent.…”

“…Previous early studies exploring psychological distress and QoL in ES patients tended to be limited to cross-sectional, retrospective studies of survivors [4–10]. Most had small numbers of participants and few were prospectively designed with a baseline measure of QoL and mental health or controlled for the context of the timepoint of the cancer journey [11–15].…”