title: Major amputations done with palliative intent in the treatment of local bony complications associated with advanced cancer.
abstract: Palliative amputations were performed on 11 patients (7 men, 4 women) with disseminated disease to control local bony complications. The average patient age was 54 years (range 14-78 years). The primary diseases were melanoma/sarcoma (seven patients) and carcinoma (four patients). All had pain; eight had intractable pain that could not be controlled by analgesics. All 11 patients had additional severe local complications, which included recurrent pathological fracture (4), sepsis (2), hemorrhage (2), radiation necrosis (2), and iliofemoral thrombosis secondary to tumor (1). Previous attempts of palliation had been made in all 11 patients, and 8 had undergone previous operative procedures (5 had undergone two or more) prior to amputation. Three anterior hemipelvectomies, five posterior hemipelvectomies, two hip disarticulations, and one forequarter amputation were performed. All patients survived the surgery, and there were no intraoperative complications. All patients received dramatic relief of pain. Postoperative complications included two cases of flap necrosis and two infections; all resolved satisfactorily. The six patients who were nonambulatory before surgery ambulated postoperatively, and two eventually ambulated with a prosthesis. Six of 11 patients survived 1 year or longer, with a median postoperative survival period of 13 months (average 16 months). Although major amputations are viewed at times as offering little to already-compromised patients, they can improve dramatically the quality of life in selected patients.
authors.affiliation: Department of Orthopedic Surgery, Children's National Medical Center, Washington, DC 20010.
authors.forename: M M
authors.initials: MM
authors.lastname: Malawer
authors.forename: R G
authors.initials: RG
authors.lastname: Buch
authors.forename: W E
authors.initials: WE
authors.lastname: Thompson
authors.forename: P H
authors.initials: PH
authors.lastname: Sugarbaker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001859:Bone Neoplasms / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D012509:Sarcoma / Q000473:pathology / Q000601:surgery