title: Amputation for extremity soft tissue sarcoma does not increase overall survival: a retrospective cohort study.
abstract: To determine if amputation increases survival when compared to limb salvage surgery in patients with a soft tissue sarcoma (STS) of the extremity when there is often a misconception among physicians and patients that ablative surgery eliminates local recurrence and increases overall survival. This retrospective cohort study assessed 278 patients with STS and compared 18 patients who had undergone amputations for soft tissue sarcomas of the extremities to a comparative cohort of 260 patients who underwent limb salvage surgery during the same time period. Our limb salvage surgery (LSS) rate was 94% overall for soft tissue sarcomas with a median follow-up of 3.1 years. Patients undergoing amputations either had tumors that involved a critical neurovascular bundle (in particular nerve rather than vessel resection was more responsible for a decision toward ablation), or underlying bone or had neoplasms whose large size would require such an enormous resection that a functional limb would not remain. In comparing prognostic effects, mainly death due to sarcoma, distant metastasis and local recurrence, it was found that there was no statistically significant difference between patients undergoing amputation to those undergoing limb salvage surgery (p > 0.05). While amputations do not increase overall survival in soft tissue sarcomas of the extremity as compared to LSS, they are still a valuable option in a surgeon's arsenal. In particular, amputations can provide improved local control and symptomatic treatment in patients who might not be candidates for limb salvage surgery.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Ave. South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774, USA.
authors.forename: V K
authors.initials: VK
authors.lastname: Alamanda
authors.forename: S N
authors.initials: SN
authors.lastname: Crosby
authors.forename: K R
authors.initials: KR
authors.lastname: Archer
authors.forename: Y
authors.initials: Y
authors.lastname: Song
authors.forename: H S
authors.initials: HS
authors.lastname: Schwartz
authors.forename: G E
authors.initials: GE
authors.lastname: Holt
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D018572:Disease-Free Survival; D005121:Extremities / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology