title: Major upper-limb amputations for malignant tumors.
abstract: OBJECTIVE
  With the continued advancement of limb salvage surgery, major upper-limb amputations are being performed less frequently and are generally reserved for patients with large, multifocal, or recurrent tumors for whom limb salvage is no longer an option. We conducted a retrospective review of the current indications and patient outcomes after major upper-limb amputations for malignant tumors.
  
  
  METHODS
  Using the institution surgical database, we identified 43 patients who underwent major upper-limb amputation for primary and metastatic malignant tumors from 1996 to 2008.
  
  
  RESULTS
  Of these 43 patients, 25 had soft tissue sarcoma, 7 had bone sarcoma, and 11 had carcinoma. Two patients had stage I, 3 had stage II, 21 had stage III, and 17 had stage IV disease. We performed 45 amputations: 5 below the elbow, 14 above the elbow, and 26 at the forequarter. Among the 45 amputations, 2 patients underwent a second more proximal amputation for local tumor recurrence. Of the 17 patients with stage IV disease, 10 underwent palliative amputation for symptom control. A total of 28 patients (65%) died. Median survival after amputation was 13 months (95% confidence interval, 8-19 mo). The 6-month cumulative incidence of local recurrence was 22%. Overall survival after forequarter amputations was 42% at 1 year.
  
  
  CONCLUSIONS
  Survival after major upper-limb amputation is poor, especially because amputations are reserved for patients with advanced tumors. However, amputation remains an option for local tumor control and can palliate symptoms in selected patients. Improvement of survival requires more effective systemic treatment strategies.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore, Singapore. mark_e_puhaindran@nuhs.edu.sg
authors.forename: Mark E
authors.initials: ME
authors.lastname: Puhaindran
authors.forename: Joanne
authors.initials: J
authors.lastname: Chou
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Forsberg
authors.forename: Edward A
authors.initials: EA
authors.lastname: Athanasian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001132:Arm / Q000601:surgery*; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate