Surgical treatment of acute limb ischaemia in the presence of malignancy.
OBJECTIVE
The aim of this study was to examine the outcome of surgical treatment of acute limb ischaemia (ALI) developing in the presence of malignancy.


METHODS
Patients undergoing emergency surgery were identified from theatre registers, notes were reviewed, and data collected in relation to indications for, and outcome following operation. All patients with a current or past medical history of histologically confirmed malignant disease were identified and their notes specifically reviewed to determine the staging of their tumours. The results of the malignancy cohort were compared to a group of patients undergoing surgery for ALI of other aetiologies.


RESULTS
Fourteen patients with a malignancy were identified with ALI and in addition there were 102 without malignancy. The cohort with a malignancy contained a higher proportion of males (p=0.0305), and a greater number of smokers (p=0.037) than those with other aetiologies for ALI. The peri-operative management of the 2 groups was similar. Histological examination revealed tumour thrombus in only 1 case. The recurrence (29% versus 18%; p=0.328) and amputation rates (29% versus 17%; p=0.278) were similar, however, the 30-day (50% versus 30%; p=0.038) and 60-day mortality rates (100% versus 35%; p<0.001) were significantly higher in the malignancy group.


CONCLUSIONS
The development of ALI in patients with malignant disease may be regarded as a terminal event despite comparable performance status at the time of surgery to those with other cause for ALI. The role of surgery in patients with known advanced malignancies appears to be of dubious benefit with little survival benefit.
Morris-Stiff
Gareth
G
Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, LLantrisant, Rhondda Cynon Taf, CF72 8XR, United Kingdom. garethmorrisstiff@hotmail.com
Lewis
Michael H
MH
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004638:Emergency Treatment; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D013927:Thrombosis / Q000209:etiology / Q000601:surgery