Amputation for Recurrent Soft Tissue Sarcoma of the Extremity: Indications and Outcome

• Main Authors: Stojadinovic, A., Jaques, D. P., Leung, Denis H. Y., Healey, J., Brennan, M. F.
• Format: text
• Language: English
• Published: Institutional Knowledge at Singapore Management University 2001
• Subjects: Econometrics; Medicine and Health Sciences
• Online Access: https://ink.library.smu.edu.sg/soe_research/466
• Institution: Singapore Management University

Limb salvage after primary site failure of extremity soft tissue sarcoma is a challenging problem. Amputation may be the most effective treatment option in selected patients with local recurrence. We compared the outcome of patients treated with amputation versus limb-sparing surgery (LSS) for locally recurrent extremity sarcoma. Methods: From 1982 to 2000, 1178 patients with localized primary extremity sarcoma underwent LSS. Of these, 204 (17%) developed local recurrence. Eighteen (9%) required major amputation and the remainder underwent LSS, of which 34 were selected for matched-pair analysis according to established prognostic variables. Rates of recurrence or death were estimated by the Kaplan-Meier method. Following adjustment for prognostic variables, a Mantel-Haenszel test was used to compare the outcome between the two treatment groups. Results: Patients in each group were well matched. All patients had high-grade tumors deep to the fascia. Median time to local recurrence was similar for both groups. Median follow-up was 95 months. Amputation was associated with a significant improvement in local control of disease (94% vs. 74%; P = .04). We observed no difference in disease-free ( P = .48), disease-specific ( P = .74), or overall survival ( P = .93) between the two groups. Median postrecurrence survival was 20 months and 5-year OS was 36% for the entire study group. Conclusions: Limb-sparing treatment achieves local control in the majority of recurrent extremity sarcomas for which amputation is infrequently indicated. Amputation improves local disease control but not survival under these circumstances.