[Ablative and extremity salvage tumor surgery of the lower extremity--a 10 year comparison].
OBJECTIVE
The treatment of choice for local tumor control was amputation in the 1970's. Nowadays, limb salvage procedures have become the new standard, implicating that limb salvage surgery results in a better quality of life. This study attempts to prove this hypothesis.


METHODS
In total, 102 patients who survived longer than ten years after tumor treatment of the lower extremities were investigated, of these, 71 patients underwent ablative procedures compared to 31 patients with limb salvage surgery. Operative revisions, education level, and occupational situation were evaluated in both groups. To analyze the outcome of every patient regarding functional results, quality of life, life contentment, and social parameters, the functional evaluation system of the Muskulo-Skeletal-Tumor Society (MSTS), the Freiburger Life-Contentment-Questionnaire (FLZ) and the Quality of Life Questionnaire (QLQ-C-30) of the European Organization of Research and treatment of Cancer (EORTC) were used.


RESULTS
Patients treated with a limb salvage procedure underwent more surgical revisions (p < 0.000). Educational level and occupational situation showed no difference in both groups. Functional results reached similar levels in both groups (74.6% vs. 73.8%). Life contentment and Quality of Life measurements showed good results in both groups. The FLZ-questionnaire showed significantly better results for the ablative group in some items.


CONCLUSIONS
The type of surgical local therapy of lower extremity tumors has no measurable effect on quality of life according to long-term follow-up in lower extremity tumors. In cases with a risk of inadequate margins when performing limb salvage surgery, an ablative procedure should be preferred.
Rödl
R
R
Klinik und Poliklinik für allgemeine Orthopädie der Westfälischen Wilhelms-Universität. roedl@uni-muenster.de
Pohlmann
U
U
Gosheger
G
G
Hoffmann
C
C
Leidinger
B
B
Lindner
N
N
Winkelmann
W
W
D000203:Activities of Daily Living / Q000145:classification; D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000639:trends*; D001859:Bone Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000601:surgery; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011788:Quality of Life; D012086:Reoperation