Oncologic Outcome and Quality of Life After Hindquarter Amputation for Sarcoma: Is it Worth it?
OBJECTIVE
Hindquarter amputations for bone or soft tissue sarcoma cause a high degree of disability. The goal of this study was to analyze oncologic outcome and quality of life after resection in order to better select patients who are more likely to benefit from this operation.


METHODS
Patients treated with a hindquarter amputation between 1989 and 2015 for a bone or soft tissue sarcoma were selected from our database. Clinical and histopathological features were analyzed for their prognostic value using Kaplan-Meier and Cox proportional hazard analysis. In addition, performance status, ambulatory status, and pain were assessed from the hospital charts for patients surviving longer than 1 year after surgery.


RESULTS
Overall, 78 patients underwent a hindquarter amputation for sarcoma. The median hospital stay was 24 days and 49% of patients had wound complications. In-hospital mortality was 6%. Overall survival for patients with metastases at presentation was significantly worse than patients with localized disease only (p = 0.001, 5-year survival 41 vs. 0%). For patients treated for localized disease, the combination of age >65 years and tumor size ≥15 cm was significantly correlated with worse metastasis-free survival (p = 0.003) and overall survival (p = 0.01). In particular, patients younger than 65 years of age who survived more than 1 year had an acceptable performance status, with reasonable pain levels and mobility.


CONCLUSIONS
Younger patients are more likely to benefit from hindquarter ampuations in terms of survival and functionality; however, for older patients with large tumors, a hindquarter amputation might not be beneficial.
University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada.|Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.|Sarcoma unit, Department of Surgery, Royal Marsden Hospital, London, UK.
Winan J
WJ
van Houdt
University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada.
Anthony M
AM
Griffin
University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada.|Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Jay S
JS
Wunder
University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada. pferguson@mtsinai.on.ca.|Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. pferguson@mtsinai.on.ca.
Peter C
PC
Ferguson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006428:Hemipelvectomy / Q000401:mortality*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D055815:Young Adult