title: Major amputation for soft-tissue sarcoma.
abstract: BACKGROUND
  Advances in oncological practice have reduced the number of major amputations performed for soft-tissue sarcoma, but this remains a valuable, if infrequent, option for both curative and palliative indications.
  
  
  METHODS
  A review of patients and case-notes was carried out from the prospective sarcoma database at the Royal Marsden Hospital.
  
  
  RESULTS
  Over a 10-year interval, 40 major amputations (18 forequarter, 17 hindquarter and five through hip) were performed, predominantly for disease recurring after previous limb-conserving surgery (31 of 40). A wide variety of soft-tissue sarcoma subtypes was seen; they were often large (more than 10 cm; 18 of 40) or multifocal (six), usually high grade (25), and frequently proximal or involving neurovascular structures such that limb salvage was precluded. Median range age of the patients was 59 (17-87) years. The operative 30-day mortality rate was zero. Hospital stay was a median of 10.5 days for forequarter amputation, and 19 days for hindquarter and through-hip amputation. Local recurrence occurred in ten patients, six of whom had concurrent distant metastases. Twenty-seven patients were alive (20 disease free) at a median follow-up of 12 months, nine of whom were alive without evidence of disease beyond 2 years. Ten patients died after a median of 7.5 months; three survived more than 2 years.
  
  
  CONCLUSIONS
  Major amputation is a useful procedure in carefully selected patients with soft-tissue sarcoma.
authors.affiliation: Melanoma and Sarcoma Unit, Royal Marsden Hospital, Fulham Road, Chelsea, London SW3 6JJ, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Clark
authors.forename: J M
authors.initials: JM
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods* / Q000534:rehabilitation; D001132:Arm; D005260:Female; D006801:Humans; D007866:Leg; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012509:Sarcoma / Q000534:rehabilitation / Q000601:surgery*; D013524:Surgical Flaps