title: Proximal major limb amputations--a retrospective analysis of 45 oncological cases.
abstract: BACKGROUND
  Proximal major limb amputations due to malignant tumors have become rare but are still a valuable treatment option in palliation and in some cases can even cure. The aim of this retrospective study was to analyse outcome in those patients, including the postoperative course, survival, pain, quality of life, and prosthesis usage.
  
  
  METHODS
  Data of 45 consecutive patients was acquired from patient's charts and contact to patients, and general practitioners. Patients with interscapulothoracic amputation (n = 14), shoulder disarticulation (n = 13), hemipelvectomy (n = 3) or hip disarticulation (n = 15) were included.
  
  
  RESULTS
  The rate of proximal major limb amputations in patients treated for sarcoma was 2.3% (37 out of 1597). Survival for all patients was 42.9% after one year and 12.7% after five years. Survival was significantly better in patients with complete tumor resections. Postoperative chemotherapy and radiation did not prolong survival. Eighteen percent of the patients with malignant disease developed local recurrence. In 44%, postoperative complications were observed. Different modalities of postoperative pain management and the site of the amputation had no significant influence on long-term pain assessment and quality of life. Eighty-seven percent suffered from phantom pain, 15.6% considered their quality of life worse than before the operation. Thirty-two percent of the patients who received a prosthesis used it regularly.
  
  
  CONCLUSIONS
  Proximal major limb amputations severely interfere with patients' body function and are the last, albeit valuable, option within the treatment concept of extremity malignancies or severe infections. Besides short survival, high complication rates, and postoperative pain, patients' quality of life can be improved for the time they have remaining.
authors.affiliation: Department of Plastic Surgery, Burn Center, Hand surgery, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany. daigeler@hotmail.com
authors.forename: Adrien
authors.initials: A
authors.lastname: Daigeler
authors.forename: Marcus
authors.initials: M
authors.lastname: Lehnhardt
authors.forename: Ammar
authors.initials: A
authors.lastname: Khadra
authors.forename: Joerg
authors.initials: J
authors.lastname: Hauser
authors.forename: Lars
authors.initials: L
authors.lastname: Steinstraesser
authors.forename: Stefan
authors.initials: S
authors.lastname: Langer
authors.forename: Ole
authors.initials: O
authors.lastname: Goertz
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Steinau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001859:Bone Neoplasms / Q000401:mortality / Q000601:surgery*; D004188:Disarticulation; D005260:Female; D006428:Hemipelvectomy; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000401:mortality / Q000601:surgery*; D010149:Postoperative Pain; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D015996:Survival Rate; D013903:Thoracic Surgery; D016896:Treatment Outcome; D034941:Upper Extremity / Q000601:surgery*