Major amputation for soft-tissue sarcoma

Abstract

Background: Advances in oncological practice have reduced the number of major amputations performed for soft-tissue sarcoma, but this remains a valuable, if infrequent, option for both curative and palliative indications.Methods: A review of patients and case-notes was carried out from the prospective sarcoma database at the Royal Marsden Hospital.Results: Over a 10-year interval, 40 major amputations (18 forequarter, 17 hindquarter and five through hip) were performed, predominantly for disease recurring after previous limb-conserving surgery (31 of 40). A wide variety of soft-tissue sarcoma subtypes was seen; they were often large (more than 10 cm; 18 of 40) or multifocal (six), usually high grade (25), and frequently proximal or involving neurovascular structures such that limb salvage was precluded. Median range age of the patients was 59 (17-87) years. The operative 30-day mortality rate was zero. Hospital stay was a median of 10·5 days for forequarter amputation, and 19 days for hindquarter and through-hip amputation. Local recurrence occurred in ten patients, six of whom had concurrent distant metastases. Twenty-seven patients were alive (20 disease free) at a median follow-up of 12 months, nine of whom were alive without evidence of disease beyond 2 years. Ten patients died after a median of 7·5 months; three survived more than 2 years. Conclusion:Major amputation is a useful procedure in carefully selected patients with soft-tissue sarcoma.

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

“…1,4,[15][16][17] Amputation is rarely required to treat these patients. [5][6][7] Extensive locally recurrent disease is a common indication for amputation. [5][6][7] We sought to characterize the factors that lead to primary amputation and to investigate whether patients undergoing primary amputation can expect an inferior oncological outcome.…”

“…[5][6][7] Extensive locally recurrent disease is a common indication for amputation. [5][6][7] We sought to characterize the factors that lead to primary amputation and to investigate whether patients undergoing primary amputation can expect an inferior oncological outcome. The factors that led to a primary amputation in this series differed on the basis of the anatomical location of the lesion.…”

“…Recent studies have focused on amputation for locally recurrent disease but not as primary surgical management at initial presentation. [5][6][7] Our aims were to identify the indications for amputation at initial presentation for patients with extremity STS and to determine whether patients who require a primary amputation have a worse prognosis than those who undergo limb-sparing surgery as the initial surgical management.…”

Microvascular reconstructions after extensive soft tissue sarcoma resections in the upper limb

“…For selected cases of proximal upper extremity or shoulder girdle tumours, even forequarteramputation is used for curation or for palliative treatment [14]. When simultaneous chest wall reconstruction is necessary, fillet flaps from the amputated extremity are useful for reconstruction [15,16].…”

Amputação interescapulotorácica sob anestesia locorregional

“…Inicialmente proposta em meados do século XIX para o tratamento de lesões traumáticas envolvendo a cintura escapular, a amputação interescapulotorácica, também tem sido empregada para o controle local de vários tipos de tumores malignos envolvendo a região da axila e ombro, onde uma operação conservadora não pôde ser indicada, devido à extensão ou características do tumor [1][2][3][4] . Tecnicamente, a amputação do ombro pode ser realizada por via anterior (Berger), posterior (Littlewood) ou por uma combinação delas 2,4 .…”