Skip to main content

Advertisement

Log in

The Indications for and the Prognostic Significance of Amputation as the Primary Surgical Procedure for Localized Soft Tissue Sarcoma of the Extremity

  • Original Article
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The indications for primary amputation of a localized soft tissue sarcoma (STS) of the extremity are not well defined in the literature. However, it has been suggested that patients who require an amputation to treat an STS are at increased risk for developing metastases. We categorized the main indications for primary amputation in our patient population and compared their oncological outcome with the outcome of patients who underwent limb-sparing surgery.

Methods

413 consecutive patients treated surgically at a single center for primary, nonmetastatic, deep, intermediate-, or high-grade STS of the extremity were reviewed. Indications for primary amputation were identified. Demographics and outcomes were compared between the amputation and limb-salvage groups. Multivariate Cox model analysis was used to identify independent risk factors for systemic relapse.

Results

Twenty-five (6%) of 413 patients with STS underwent primary amputation: they were older (P = .05), had larger tumors (P = .001), and had a significantly greater risk of developing metastatic disease than patients who underwent limb-sparing procedures (P = .008). However, multivariate analysis demonstrated that the only independent predictors of systemic relapse were tumor size (P = .0001) and tumor grade (P = .0001). Primary amputation was not an independent risk factor for metastatic disease.

Conclusions

The decision to perform a primary amputation for an STS of the extremity is based on the location and local extent of the tumor, and the expected function of the extremity after tumor resection. The higher risk of metastases for patients who require primary amputation is accounted for by independent risk factors associated with their tumors—predominantly large tumor size.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

FIG. 1
FIG. 2
FIG. 3
FIG. 4

Similar content being viewed by others

References

  1. WC Williard C Collin ES Casper SI Hajdu MF Brennan (1992) ArticleTitleThe changing role of amputation for soft tissue sarcoma of the extremity in adults Surg Gynecol Obstet 175 389–96

    Google Scholar 

  2. S Vraa J Keller OS Nielsen O Sneppen AG Jurik OM Jensen (1998) ArticleTitlePrognostic factors in soft tissue sarcomas: the Aarhus experience Eur J Cancer 34 1876–82 Occurrence Handle10.1016/S0959-8049(98)00233-0 Occurrence Handle1:STN:280:DyaK1M7ksleqsg%3D%3D Occurrence Handle10023309

    Article  CAS  PubMed  Google Scholar 

  3. RR Eilber JJ Mirra TT Grant (1980) ArticleTitleIs amputation necessary for sarcomas? Ann Surg 192 431–7

    Google Scholar 

  4. SA Rosenberg J Tepper E Glatstein et al. (1982) ArticleTitleThe treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy Ann Surg 196 305–15 Occurrence Handle1:STN:280:Bi2B1c3psVQ%3D Occurrence Handle7114936

    CAS  PubMed  Google Scholar 

  5. MA Clark JM Thomas (2003) ArticleTitleMajor amputation for soft-tissue sarcoma Br J Surg 90 102–7

    Google Scholar 

  6. MA Clark JM Thomas (2003) ArticleTitleAmputation for soft-tissue sarcoma Lancet 4 335–42

    Google Scholar 

  7. A Stojadinovic DP Jaques DH Leung JH Healey MF Brennan (2001) ArticleTitleAmputation for recurrent soft tissue sarcoma of the extremity: indications and outcome Ann Surg Oncol 8 509–18

    Google Scholar 

  8. FL Kaplan P Meier (1958) ArticleTitleNon-parametric estimation from incomplete observations J Am Stat Assoc 53 453–81

    Google Scholar 

  9. DR Cox (1972) ArticleTitleRegression models and life-tables (with discussion) J R Stat Soc B 34 187–220

    Google Scholar 

  10. J Costa RA Wesley E Glatstein SA Rosenberg (1984) ArticleTitleThe grading of soft tissue sarcomas. Results of a clinicohistopathological correlation in a series of 163 cases Cancer 53 530–41

    Google Scholar 

  11. JS Wunder JH Healey AM Davis MF Brennan (2000) ArticleTitleA comparison of staging systems for localized extremity soft tissue sarcoma Cancer 88 2721–30

    Google Scholar 

  12. FL Greene ID Fleming A Fritz CM Balch DG Haller M Morrow (Eds) (2002) AJCC Cancer Staging Manual EditionNumber6 Springer-Verlag New York

    Google Scholar 

  13. MF Brennan (1989) ArticleTitleManagement of extremity soft-tissue sarcoma Am J Surg 158 71–8

    Google Scholar 

  14. CS Trovik HF Bauer TA Alvegard (2000) ArticleTitleSurgical margins, local recurrence and metastases in soft tissue sarcomas: 559 surgically treated patients from the Scandinavian Sarcoma Group Register Eur J Cancer 36 710–6

    Google Scholar 

  15. WC Williard SI Hajdu ES Casper MF Brennan (1992) ArticleTitleComparison of amputation with limb-sparing operations for adult soft tissue sarcoma of the extremity Ann Surg 215 269–75

    Google Scholar 

  16. CP Karakousis LJ Emrich U Rao RM Krishnamsetty (1986) ArticleTitleFeasibility of limb salvage and survival in soft tissue sarcomas Cancer 57 484–91

    Google Scholar 

  17. DA Potter T Kinsella E Glatstein et al. (1986) ArticleTitleHigh-grade soft tissue sarcomas of the extremities Cancer 58 190–205

    Google Scholar 

  18. AH Kawaii H Hashizume H Inoue H Uchida S Sano (1996) ArticleTitleVascular reconstruction in limb salvage operations for soft tissue tumours of the extremities Clin Orthop 332 215–22

    Google Scholar 

  19. DB Drake (1995) ArticleTitleReconstruction for limb-sparing procedures in soft-tissue sarcomas of the extremities Clin Plast Surg 22 123–8

    Google Scholar 

  20. AM Imparato DF Roses KC Francis MM Lewis (1978) ArticleTitleMajor vascular reconstruction for limb salvage in patients with soft tissue and skeletal sarcomas of the extremities Surg Gynecol Obstet 147 891–6

    Google Scholar 

  21. SM Kumta KM Yip YL Lee J Lin PC Leung (1995) ArticleTitleLimb salvage surgery with microsurgical reconstruction for the treatment of musculoskeletal tumours involving the upper extremity Ann Acad Med Singapore 24 IssueID4 Suppl 8–14

    Google Scholar 

  22. RN Nambisan CP Karakousis (1987) ArticleTitleVascular reconstruction for limb salvage in soft tissue sarcomas Surgery 101 668–77

    Google Scholar 

  23. JM Serletti SR Hurwitz JA Jones (1993) ArticleTitleExtension of limb salvage by combined vascular reconstruction and adjunctive free-tissue transfer J Vasc Surg 18 978–80

    Google Scholar 

  24. B Fuchs AM Davis JS Wunder et al. (2001) ArticleTitleSciatic nerve resection in the thigh: a functional evaluation Clin Orthop 382 34–41

    Google Scholar 

  25. B O’Sullivan J Wylie C Catton et al. (1999) ArticleTitleThe local management of soft tissue sarcoma Semin Radiat Oncol 9 328–48

    Google Scholar 

  26. S Noria A Davis R Kandel et al. (1996) ArticleTitleResidual disease following unplanned excision of soft-tissue sarcoma of an extremity J Bone Joint Surg Am 78 650–5

    Google Scholar 

  27. KA Siebenrock R Hertel R Ganz (2000) ArticleTitleUnexpected resection of soft-tissue sarcoma. More mutilating surgery, higher local recurrence rates, and obscure prognosis as consequences of improper surgery Arch Orthop Trauma Surg 120 65–9

    Google Scholar 

  28. AM Davis RA Kandel JS Wunder et al. (1997) ArticleTitleThe impact of residual disease on local recurrence in patients treated by initial unplanned resection for soft tissue sarcoma of the extremity J Surg Oncol 66 81–7

    Google Scholar 

  29. C Collin J Godbold S Hajdu M Brennan (1987) ArticleTitleLocalized extremity soft tissue sarcoma: an analysis of factors affecting survival J Clin Oncol 5 601–12

    Google Scholar 

  30. CF Collin C Friedrich J Godbold S Hajdu MF Brennan (1988) ArticleTitlePrognostic factors for local recurrence and survival in patients with localized extremity soft-tissue sarcoma Semin Surg Oncol 4 30–7

    Google Scholar 

  31. CP Karakousis DL Driscoll (1999) ArticleTitleTreatment and local control of primary extremity soft tissue sarcomas J Surg Oncol 71 155–61

    Google Scholar 

  32. CP Karakousis C Proimakis DL Walsh (1995) ArticleTitlePrimary soft tissue sarcoma of the extremities in adults Br J Surg 82 1208–12 Occurrence Handle1:STN:280:BymD3s%2Fkt1Y%3D Occurrence Handle7551998

    CAS  PubMed  Google Scholar 

  33. J Lewis D Leung M Heslin J Woodruff M Brennan (1997) ArticleTitleAssociation of local recurrence with subsequent survival in extremity soft tissue sarcoma J Clin Oncol 15 646–52

    Google Scholar 

Download references

Acknowledgments

A.M.D. is supported by a Health Career Award from the Canadian Institutes of Health Research. This study was supported by the Canadian Institutes of Health Research.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jay S. Wunder MD, MSc, FRCSC.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ghert, M.A., Abudu, A., Driver, N. et al. 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, 10–17 (2005). https://doi.org/10.1007/s10434-004-1171-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-004-1171-3

Keywords

Navigation