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

Abstract

Background Major amputations are indicated for advanced tumors when limb-preservation techniques have been exhausted. Radical surgery can result in significant palliation and possible cure. Methods We identified 40 patients who underwent forequarter (FQ) or hindquarter (HQ) amputations between May 2000 and January 2011. Patient demographics, tumor-related factors, and outcomes were reviewed. Results There were 30 FQ and 10 HQ amputations. The most common diagnoses were sarcoma (55%) and squamous cell carcinoma (25%). Patients presented with primary tumors (35%), regional recurrence (57.5%), or unresectable limb metastatic disease (7.5%). Presenting symptoms included fungating wounds (35%), intractable pain (78%), and limb dysfunction (65%). Operations were performed with curative intent (10%), curative/palliative intent (70%), or palliation alone (20%). Wound complications occurred in 35%. Pain was improved in 78% of patients following surgery. Despite a 91% negative margin rate, 79% of patients recurred either locally or distantly. Median overall survival was 10.9, 13.2, and 3.4 months in the curative, curative/palliative, and palliative groups, respectively. Conclusions In the absence of conservative options, major amputations are indicated for the management of advanced tumors. These operations can be performed safely, resulting in effective palliation of debilitating symptoms. While recurrence rates remain high, some patients can achieve prolonged survival.

A systematic review and meta‐analysis of locoregional treatments for in‐transit melanoma

“…Table summarizes the key data for each modality and presents the pooled results including the weighted ORR and meta‐analysis data. Assessed studies included: randomized controlled trials, nonrandomized phase I and II comparative and noncomparative studies, and prospective or retrospective case series (NHMRC levels II–IV evidence; Tables S2‐S9) . Only two therapies: amputation and topical imiquimod, were suitable for formal meta‐analysis ( I 2 value ≤ 40%).…”

Outcomes of Surgical Treatment of Skin Cancer at Surgical Oncology Unit of Donka, Conakry University Hospital

“…Amputations and disarticulations were both curative and palliative before these tumors ulcerated, sometimes haemorrhagic and very painful. This surgical strategy is reported in several studies [7] [9] [10]. However, because of the reluctance of many of the patients to accept amputation as an option, less adequate local excision was done.…”

Hemipelvectomy

“…14 Length and extent of the operation and surgical wound class were statistically significant variables that were associated with development of wound infection and flap necrosis. 12,21,22 One factor that has been shown to increase the risk for phantom pain and one of the most common chief complaints of patients undergoing hemipelvectomy is poorly controlled preoperative pain. 14 All types of soft tissue flaps have been shown to provide adequate immediate soft tissue coverage.…”

“…14,20 Although spinal or visceral resection increased wound infection rate, it did not increase flap necrosis rates. 22,23 Unlike phantom pain, residual limb spasm is more typically seen after traumatic amputation. The level of vascular ligation strongly influences posterior hemipelvectomy flap necrosis.…”

“…12,21,22 One factor that has been shown to increase the risk for phantom pain and one of the most common chief complaints of patients undergoing hemipelvectomy is poorly controlled preoperative pain. 22 12 Residual limb spasm is a movement disorder (dyskinesia) that occurs weeks to months after amputation.…”