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Contemporary role of amputation for patients with extremity soft tissue sarcoma

  • Author Footnotes
    1 equally contributed.
    Lorenzo Conti
    Footnotes
    1 equally contributed.
    Affiliations
    Department of Surgery - ASST Sette Laghi, Varese, Italy
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  • Author Footnotes
    1 equally contributed.
    Fahmina Buriro
    Footnotes
    1 equally contributed.
    Affiliations
    Department of Surgery, Patel Hospital, Karachi, Pakistan

    European School of Soft Tissue Sarcoma Surgery, ESSO, Brussels, Belgium
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  • Author Footnotes
    1 equally contributed.
    Marco Baia
    Footnotes
    1 equally contributed.
    Affiliations
    Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy

    Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital Birmingham, UK
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  • Sandro Pasquali
    Affiliations
    Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy
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  • Rosalba Miceli
    Affiliations
    Clinical Epidemiology and Trial Organization, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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  • Laura De Rosa
    Affiliations
    Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy

    Department of Orthopedic Surgery, ASST Monza Ospedale San Gerardo, Italy
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  • Alessandro Gronchi
    Affiliations
    Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy
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  • Marco Fiore
    Correspondence
    Corresponding author. Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milano, Italy.
    Affiliations
    Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy
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  • Author Footnotes
    1 equally contributed.
Published:December 08, 2022DOI:https://doi.org/10.1016/j.ejso.2022.12.002

      Abstract

      Introduction

      limb-sparing surgery is the mainstream treatment for primary extremity soft tissue sarcoma (ESTS) at referral centers, following advances in surgical reconstructions and multimodal management. However, amputation is still needed in selected patients and has not yet been described for a ESTS cohort in a contemporary scenario.

      Material and methods

      consecutive patients who underwent surgery for primary ESTS from 2006 to 2018 were extracted from a prospectively collected database at our reference center. Patients receiving amputation for either primary tumor or local recurrence (LR) after limb-sparing surgery were selected for analysis.

      Results

      Among 1628 primary ESTS, 29 patients underwent primary amputation (1.8%), 22/1159 (1.9%) for upper limb and 7/469 (1.5%) for lower limb ESTS. Patients were mainly affected by grade III FNCLCC (89.6%) of notable dimension (median size 16 cm, IQR 10–24). 65.5% of patients received preoperative treatments (systemic or regional chemotherapy, radiotherapy or chemo-radiation). Secondary amputation for LR was performed after a median of 23 months in 16/1599 patients (1%). Median survival time was 16.2 and 29.6 months after primary or secondary amputation respectively. Factors prompting the need for a primary amputation were most often a combination of multifocal disease, bone invasion and pain or neurovascular bundle involvement and relevant comorbidities, mainly for grade III tumors in elderly patients.

      Conclusion

      Contemporary rate of amputation for ESTS at a reference center is extremely low. Still, amputation is required in selected cases with advanced presentations, especially in elderly, frail patients.

      Keywords

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