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Connective Tissue Oncology Society |
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| 2001 CTOS Annual Meeting Posters— Surgery THE INDICATIONS
AND PROGNOSTIC SIGNIFICANCE OF AMPUTATION FOR SOFT TISSUE SARCOMA
OF THE EXTREMITY OBJECTIVE: Limb preserving surgery has become the treatment of choice for patients with soft tissue sarcoma but a small group of patients remain unsuitable for limb preserving surgery and require amputation for the local control of their sarcoma. The prognostic significance of the need for amputation to achieve local control in patients with soft tissue sarcoma is unclear. We studied patients with soft tissue sarcoma of the extremity to determine the reasons for amputation, and the outcome following amputation compared to those patients treated with limb preserving surgery. METHODS: The clinical charts, prospectively collected database records, radiological investigations and pathological records of patients with soft tissue sarcoma treated at our centre were studied. The patients who had primary amputation, and those who had amputation after complications of limb sparing surgery, were studied to identify the reasons for amputations. RESULTS: 812 consecutive patients were studied. 774 patients (95.3%) had limb-sparing surgery and 38 (4.7%) had primary amputations. Patients with primary amputations were statistically more likely to have metastases at presentation (16% versus 7%), high grade tumours (82% versus 49%), larger tumours (median diameter 11cm versus 7cm) and were older (61 versus 53 years). Multivariate analysis using time dependent Cox model in patients with localised disease at diagnosis revealed that the requirement for primary amputation was a poor prognostic factor for overall and disease free survival independent of tumour grade, tumour size and patients’ age. The reasons for primary amputation were: 1) tumour excision would result in inadequate function (13 of 38 patients); 2) large extracompartmental tumours with composite tissue involvement including major vessels, nerves and bone (eight of 38 patients); 3) local recurrence in previously irradiated field (seven of 38 patients); 4) involvement of major neurovascular structures (five of 38 patients); 5) prior unplanned resection with extensive tissue contamination (three of 38 patients); 6) multifocal disease (one of 38 patients) and 7) concurrent peripheral vascular disease (one of 38 patients). CONCLUSION: Patients who require primary amputations are a select group with unfavourable tumour characteristics and have a poor prognosis. The are likely to present with metastases and those with localised disease at the time of treatment develop metastases much earlier compared to patients in whom limb preserving surgery is possible. The requirement for a primary amputation is an independent poor prognostic factor in patients with localised disease at diagnosis.
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