A Comparative Study of Amputation and Limb Salvage for Musculoskeletal Sarcoma

Fifty-three rimary musculoskeletal sarcomata (36 with bone and 17 with soft tissue lesions) were operated on over a period of 11 years. Before July 1981, the Surgical Staging System (SSS) introduced by Enneking had not yet been adopted by our institute (pre-SSS), 16 sarcomas had undergone operation. After adoption of SSS, 34 patients with musculoskeletal sarcoma were treated. The cumulative survival rate (CSR) of the pre-SSS group was as follows: 1 year, 81.2%; 3 years, 37.5%; and 5 years, 36.8%. On the other hand, the CSR of the post-SSS group was as follows: 1 year, 84.1%; 3 years, 76.1%; and 5 years, 67.7% retrospectively. A statistically significant difference was evident. With respect to stage II lesions, 5-year-CSR of the pre-SSS is calculated as 30.7%, while that of the post-SSS is 61.7%. There was high incidence of advanced and high-grade malignancies in the pre-SSS group. Surgical procedures performed in the pre-SSS group were mainly wide or radical amputation. However in the post-SSS group, limb saving procedure (n = 23) and amputation (n = 8) were initially carried out. Five-year-CSR of limb salvage is calculated as 78.5%, while that of amputation is 62.5%. Local recurrence was seen in 5 of 16 cases in the pre-SSS. Surgical margin of these recurrent cases was estimated as marginal or intralesional. We conclude that a limb salvage procedure does not increase the frequency of local recurrences and that both limb salvage and amputation offer a similarly good prognosis if the surgical stagig system is strictly adapted.