title: Does increased rate of limb-sparing surgery affect survival in osteosarcoma?
abstract: BACKGROUND
  The emergence of limb salvage surgery as an option for patients with osteosarcoma is attributable to preoperative chemotherapy and advancements in musculoskeletal imaging and surgical technique. While the indications for limb salvage have greatly expanded it is unclear whether limb salvage affects overall survival.
  
  
  OBJECTIVE
  We asked whether over the past three decades limb-sparing procedures in high-grade osteosarcoma had increased, and whether this affected survival and ultimate amputation.
  
  
  METHODS
  We retrospectively reviewed 251 patients with high-grade osteosarcoma treated from 1980 to 2004 with a multidisciplinary approach, including neoadjuvant chemotherapy. We compared survival rates, limb-salvage treatment, and amputation after limb-sparing procedure during three different periods of time. Fifty-three patients were treated from 1980 to 1989, 97 from 1990 to 1999, and 101 from 2000 to 2004. Thirty-seven patients were treated with primary amputations and 214 with primary limb salvage.
  
  
  RESULTS
  The 5-year survival rate in the first period was 36%, whereas in the 1990 s, it was 60% and 67% from 2000-2004. Limb salvage surgery rate in the 1980s was 53% (28 of 53), whereas in the 1990 s, it was 91% (88 of 97) and 97% from 2000-2004 (98 of 101). In the limb salvage group, 22 of the 214 patients (10%) required secondary amputation; the final limb salvage rate in the first period was 36% (19 of 53), whereas in the 1990 s, it was 81% (79 of 97) and 93% from 2000-2004 (94 of 101).
  
  
  CONCLUSIONS
  Patients with osteosarcoma treated in the last two periods had higher rates of limb salvage treatment and survival, with lower secondary amputation.
authors.affiliation: Institute of Orthopedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Potosí 4247, 1199, Buenos Aires, Argentina, miguel.ayerza@hospitalitaliano.org.ar
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Ayerza
authors.forename: Germán L
authors.initials: GL
authors.lastname: Farfalli
authors.forename: Luis
authors.initials: L
authors.lastname: Aponte-Tinao
authors.forename: D Luis
authors.initials: DL
authors.lastname: Muscolo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001118:Argentina / Q000453:epidemiology; D001859:Bone Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D012516:Osteosarcoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult