title: Amputation for recurrent soft tissue sarcoma of the extremity: indications and outcome.
abstract: BACKGROUND
  Limb salvage after primary site failure of extremity soft tissue sarcoma is a challenging problem. Amputation may be the most effective treatment option in selected patients with local recurrence. We compared the outcome of patients treated with amputation versus limb-sparing surgery (LSS) for locally recurrent extremity sarcoma.
  
  
  METHODS
  From 1982 to 2000, 1178 patients with localized primary extremity sarcoma underwent LSS. Of these, 204 (17%) developed local recurrence. Eighteen (9%) required major amputation and the remainder underwent LSS, of which 34 were selected for matched-pair analysis according to established prognostic variables. Rates of recurrence or death were estimated by the Kaplan-Meier method. Following adjustment for prognostic variables, a Mantel-Haenszel test was used to compare the outcome between the two treatment groups.
  
  
  RESULTS
  Patients in each group were well matched. All patients had high-grade tumors deep to the fascia. Median time to local recurrence was similar for both groups. Median follow-up was 95 months. Amputation was associated with a significant improvement in local control of disease (94% vs. 74%; P = .04). We observed no difference in disease-free (P = .48), disease-specific (P = .74), or overall survival (P = .93) between the two groups. Median postrecurrence survival was 20 months and 5-year OS was 36% for the entire study group.
  
  
  CONCLUSIONS
  Limb-sparing treatment achieves local control in the majority of recurrent extremity sarcomas for which amputation is infrequently indicated. Amputation improves local disease control but not survival under these circumstances.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: A
authors.initials: A
authors.lastname: Stojadinovic
authors.forename: D P
authors.initials: DP
authors.lastname: Jaques
authors.forename: D H
authors.initials: DH
authors.lastname: Leung
authors.forename: J H
authors.initials: JH
authors.lastname: Healey
authors.forename: M F
authors.initials: MF
authors.lastname: Brennan
mesh_terms: D000671:Amputation, Surgical; D018572:Disease-Free Survival; D005121:Extremities / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D023821:Limb Salvage; D008297:Male; D016555:Matched-Pair Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome