Less Is (Usually) More: When Is Amputation Appropriate for Treatment of Extremity Soft Tissue Sarcoma?
- Gary N. Mann MD
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Limb-salvage surgery, combining wide excision and radiotherapy, is the standard of treatment for patients with extremity soft tissue sarcoma. In the only randomized study comparing amputation with limb preservation, Rosenberg et al.1 demonstrated that despite slightly higher local recurrence rates, limb salvage was not detrimental to patient survival. This is a common finding in solid tumor biology: organ preservation is not associated with worse overall survival, even though patients often have more local recurrences. Indeed, breast-conservation therapy is preferred over mastectomy and has been proven to be as effective in multiple randomized studies.2 We also see this, for example, in such diverse tumors as laryngeal cancer3 and anorectal melanoma.4 This trend of “less is more” in surgery is well founded and leads to improved patient satisfaction and quality of life (QOL) without compromising quantity of life.
In this issue of Annals of Surgical Oncology, Ghert et al. 5 from the Princ ...
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- The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med 324: pp. 1685-90 CrossRef
- Droesch J, Flum DR, Mann GN. Wide local excision or abdomino-perineal resection as the initial treatment for anorectal melanoma? Am J Surg 2005 (in press)
- Ghert, MA, Abudu, A, Driver, N (2005) The indications for and the prognostic significance of amputation as the primary surgical procedure for localized soft tissue sarcoma of the extremity. Ann Surg Oncol 12: pp. .
- O’Sullivan, B, Davis, AM, Turcotte, R (2002) Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomized trial. Lancet 359: pp. 2235-41 CrossRef
- Davis, AM, O’Sullivan, B, Bell, RS (2002) Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol 20: pp. 4472-7
- Brooks, AD, Gold, JS, Graham, D (2002) Resection of the sciatic, peroneal, or tibial nerves: assessment of functional status. Ann Surg Oncol 9: pp. 41-7
- Merimsky, O, Kollender, Y, Inbar, M (2001) Is forequarter amputation justified for palliation of intractable cancer symptoms?. Oncology 60: pp. 55-9
- Less Is (Usually) More: When Is Amputation Appropriate for Treatment of Extremity Soft Tissue Sarcoma?
Annals of Surgical Oncology
Volume 12, Issue 1 , pp 1-2
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- Gary N. Mann MD (1)
- Author Affiliations
- 1. Department of Surgery, University of Washington, Box 356410, 1959 N.E. Pacific Street, Seattle, Washington, 98195