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Limb Salvage Versus Amputation in Conventional Appendicular Osteosarcoma: a Systematic Review

Indian Journal of Surgical Oncology volume 9, pages 232–240 (2018)Cite this article

Abstract

The overall survivorship in patients with appendicular osteosarcoma has increased in the past few decades. However, controversies and questions about performing an amputation or a limb salvage procedure still remain. Using three peer-reviewed library databases, a systematic review of the literature was performed to evaluate all studies that have evaluated the outcomes of appendicular osteosarcoma, either with limb salvage or amputation. The mean 5-year overall survivorship was 62% for salvage and 58% for amputation (p > 0.05). At mean 6-year follow-up, the local recurrence rates were 8.2% for salvage and 3.0% for amputation (p > 0.05). Additionally, at mean 6-year follow-up, the rate for metastasis was 33% for salvage and 38% for amputation (p > 0.05). The revision rates were higher with salvage (31 vs. 28%), and there were more complications in the salvage groups (52 vs. 34%; p > 0.05). Despite the heterogeneity of studies available for review, we observed similar survival rates between the two procedures. Although there was no significant statistical difference between rates of recurrence and metastasis, the local recurrence rate and risk of complications were higher for limb salvage as compared to amputation. Cosmetic satisfaction is often higher with limb salvage, whereas long-term expense is higher with amputation. Overall, current literature supports limb salvage procedures when wide surgical margins can be achieved while still retaining a functional limb.

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Funding

This study was performed without external funding.

Author information

Affiliations

  1. Department of Orthopaedics, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Suite 300, Baltimore, MD, 21201, USA

    Julio J. Jauregui, Vidushan Nadarajah & Daniel M. Lerman

  2. Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, 11203, USA

    Vidushan Nadarajah, Robert Pivec, Bhaveen H. Kapadia & Aditya V. Maheshwari

  3. Department of Orthopaedic Surgery, Stony Brook School of Medicine, Stony Brook, NY, 11794, USA

    Joseph Munn

  4. Division of Musculoskeletal Oncology and Adult Reconstruction, SUNY Downstate Medical Center, Brooklyn, NY, 11203, USA

    Aditya V. Maheshwari

Authors
  1. Julio J. Jauregui
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  2. Vidushan Nadarajah
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  4. Robert Pivec
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  5. Bhaveen H. Kapadia
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  7. Aditya V. Maheshwari
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Correspondence to Julio J. Jauregui.

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Conflicts of Interest

Aditya V. Maheshwari is on the editorial and/or governing board of the World Journal of Orthopedics.

Bhaveen H. Kapadia is a paid consultant and paid presenter and speaker of Sage Products, LLC.

For the remaining authors, they declare that they have no conflicts of interest to disclose.

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Jauregui, J.J., Nadarajah, V., Munn, J. et al. Limb Salvage Versus Amputation in Conventional Appendicular Osteosarcoma: a Systematic Review. Indian J Surg Oncol 9, 232–240 (2018). https://doi.org/10.1007/s13193-018-0725-y

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  • DOI: https://doi.org/10.1007/s13193-018-0725-y

Keywords

  • Osteosarcoma
  • Limb salvage
  • Amputation
  • Survivorship
  • Complications
  • Survival rate