Palliative forequarter amputation for metastatic carcinoma to the shoulder girdle region: Indications, preoperative evaluation, surgical technique, and results

Abstract

Background and Objectives Uncontrolled metastatic carcinoma of the shoulder girdle is a difficult oncologic problem. This study reviews our experience with palliative forequarter amputation with emphasis on patient selection criteria, preoperative radiologic assessment, surgical technique, epineural postoperative analgesia, and clinical outcome. Methods Eight patients who underwent palliative forequarter amputation for metastatic carcinoma between 1980 and 1999 were analyzed retrospectively. Diagnoses included breast carcinoma (n = 3), squamous cell carcinoma (n = 2), hypernephroma (n = 2), and carcinoma of unknown origin (n = 1). All patients presented with severe, intractable pain and a useless extremity. Venography demonstrated obliteration of the axillary vein in each of the patients in whom this procedure was performed. Exploration of the brachial plexus confirmed tumor encasement and unresectability in all patients. Epineural catheters for bupivacaine infusion were placed for postoperative pain control. Results All patients experienced dramatic pain relief and improved mobility and overall function. Life‐threatening hemorrhage and sepsis were alleviated. There were no instances of phantom limb pain or adverse psychological reactions, and no complications related to epineural analgesia. Conclusions Palliative forequarter amputation is relatively safe and reliable and provides effective pain relief for selected patients with unresectable metastatic carcinoma to the axilla and bony shoulder girdle in whom radiotherapy and/or chemotherapy has not been effective. The triad of pain, motor loss, and an obliterated axillary vein is indicative of brachial plexus infiltration and unresectability. J. Surg. Oncol. 2001; 77:105–113. © 2001 Wiley‐Liss, Inc.

The role of radical amputations for extremity tumors: A single institution experience and review of the literature

“…The incidence of complications following HQ amputations ranges from 50% to 80% 18, 29, 35. Complication rates following FQ amputation are generally lower 12, 25, 31. Most postoperative complications are due to wound infection and flap necrosis.…”

“…Tumors invading proximal nerves and vessels often make limb preservation impossible, leaving a radical amputation as the only surgical option and the only chance for long‐term survival. The indications for proximal amputation are well described and include intractable pain, neurovascular compromise, fungating growth, and the inability to maintain limb function with complete resection 8–12. Amputation of the affected extremity can result in palliation of these tumor‐related complications.…”

Forequarter amputation for malignancy

“…Palliative FQA may be indicated in selected patients with axillary and limb metastatic disease who have uncontrollable clinical complications, to improve quality of life and daily function2–5.…”

Reconstruction with constrained scapular prosthesis after total scapulectomy for scapular malignant tumor

“…The most common tumors are chondrosarcoma, Ewing's sarcoma, and metastatic tumors . Because of the specific anatomy of the shoulder area, there are no distinct symptoms associated with scapular tumors in early stages . These tumors often grow quite large before being diagnosed, and they can invade the chest wall, rotator cuff, proximal humerus, and axillary neurovascular sheath during disease progression.…”

“…1 Because of the specific anatomy of the shoulder area, there are no distinct symptoms associated with scapular tumors in early stages. [2][3][4][5] These tumors often grow quite large before being diagnosed, and they can invade the chest wall, rotator cuff, proximal humerus, and axillary neurovascular sheath during disease progression. Historically, the common method of managing these cases was forequarter amputation.…”