title: The role of radical amputations for extremity tumors: a single institution experience and review of the literature.
abstract: BACKGROUND
  Major amputations are indicated for advanced tumors when limb-preservation techniques have been exhausted. Radical surgery can result in significant palliation and possible cure.
  
  
  METHODS
  We identified 40 patients who underwent forequarter (FQ) or hindquarter (HQ) amputations between May 2000 and January 2011. Patient demographics, tumor-related factors, and outcomes were reviewed.
  
  
  RESULTS
  There were 30 FQ and 10 HQ amputations. The most common diagnoses were sarcoma (55%) and squamous cell carcinoma (25%). Patients presented with primary tumors (35%), regional recurrence (57.5%), or unresectable limb metastatic disease (7.5%). Presenting symptoms included fungating wounds (35%), intractable pain (78%), and limb dysfunction (65%). Operations were performed with curative intent (10%), curative/palliative intent (70%), or palliation alone (20%). Wound complications occurred in 35%. Pain was improved in 78% of patients following surgery. Despite a 91% negative margin rate, 79% of patients recurred either locally or distantly. Median overall survival was 10.9, 13.2, and 3.4 months in the curative, curative/palliative, and palliative groups, respectively.
  
  
  CONCLUSIONS
  In the absence of conservative options, major amputations are indicated for the management of advanced tumors. These operations can be performed safely, resulting in effective palliation of debilitating symptoms. While recurrence rates remain high, some patients can achieve prolonged survival.
authors.affiliation: Sarcoma Program, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Colin M
authors.initials: CM
authors.lastname: Parsons
authors.forename: Jose M
authors.initials: JM
authors.lastname: Pimiento
authors.forename: David
authors.initials: D
authors.lastname: Cheong
authors.forename: Suroosh S
authors.initials: SS
authors.lastname: Marzban
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Gonzalez
authors.forename: David
authors.initials: D
authors.lastname: Johnson
authors.forename: G Douglas
authors.initials: GD
authors.lastname: Letson
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005121:Extremities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010166:Palliative Care; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012196:Review Literature as Topic; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D055815:Young Adult