Clinical outcome in patients who underwent amputation due to extremity soft tissue sarcoma: Tokai Musculoskeletal Oncology Consortium study
Tomohito HagiTomoki NakamuraAkihito NaganoHiroshi KoikeKenji YamadaHisaki AibaNasa FujiharaJunji WasaKunihiro AsanumaEiji KozawaDaisuke IshimuraKatsuhisa KawanamiYuya IzubuchiYoji ShidoAkihiro SudoYoshihiro Nishida
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Abstract:
Soft tissue sarcomas are a diverse group of rare malignant tumours, mostly occurring in the lower extremities. Amputations are necessary for achieving local control when the soft tissue sarcomas are too large and/or have neurovascular involvement. Patients who require amputation have a poorer prognosis than those who undergo limb-salvage surgery.We investigated the tumour characteristics and the clinical outcomes in 55 patients with primary soft tissue sarcomas, who underwent amputation. We excluded patients with amputation performed distal to the wrist or ankle joints and those with recurrent soft tissue sarcomas.The mean tumour size was 11.1 cm. Hip disarticulation was performed in 6 patients, 20 underwent above the knee amputation, 8 underwent knee disarticulation and 12 underwent below the knee amputation. Shoulder disarticulation was performed in three patients, five underwent above the elbow amputation, and one underwent below the elbow amputation. The 5-year disease-specific survival rate was 52.8%. The 5-year recurrence-free survival rate and 5-year metastasis-free survival rates were 90.1% and 38.5%, respectively. Larger tumour size, age and the distant metastases at first presentation were predictors of poor prognosis for survival in multivariate analysis. Twenty-eight patients could walk using artificial limbs. The level of amputation (above versus below the knee) showed a significant difference in achieving independent gait.Amputation is a useful treatment option for achieving local control in patients with large soft tissue sarcomas. Patients had an opportunity of walking, especially for those who underwent below the knee amputation.Keywords:
Disarticulation
Hemipelvectomy
Soft tissue sarcomas are a diverse group of rare malignant tumours, mostly occurring in the lower extremities. Amputations are necessary for achieving local control when the soft tissue sarcomas are too large and/or have neurovascular involvement. Patients who require amputation have a poorer prognosis than those who undergo limb-salvage surgery.We investigated the tumour characteristics and the clinical outcomes in 55 patients with primary soft tissue sarcomas, who underwent amputation. We excluded patients with amputation performed distal to the wrist or ankle joints and those with recurrent soft tissue sarcomas.The mean tumour size was 11.1 cm. Hip disarticulation was performed in 6 patients, 20 underwent above the knee amputation, 8 underwent knee disarticulation and 12 underwent below the knee amputation. Shoulder disarticulation was performed in three patients, five underwent above the elbow amputation, and one underwent below the elbow amputation. The 5-year disease-specific survival rate was 52.8%. The 5-year recurrence-free survival rate and 5-year metastasis-free survival rates were 90.1% and 38.5%, respectively. Larger tumour size, age and the distant metastases at first presentation were predictors of poor prognosis for survival in multivariate analysis. Twenty-eight patients could walk using artificial limbs. The level of amputation (above versus below the knee) showed a significant difference in achieving independent gait.Amputation is a useful treatment option for achieving local control in patients with large soft tissue sarcomas. Patients had an opportunity of walking, especially for those who underwent below the knee amputation.
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Abstract Background Advances in oncological practice have reduced the number of major amputations performed for soft-tissue sarcoma, but this remains a valuable, if infrequent, option for both curative and palliative indications. Methods A review of patients and case-notes was carried out from the prospective sarcoma database at the Royal Marsden Hospital. Results Over a 10-year interval, 40 major amputations (18 forequarter, 17 hindquarter and five through hip) were performed, predominantly for disease recurring after previous limb-conserving surgery (31 of 40). A wide variety of soft-tissue sarcoma subtypes was seen; they were often large (more than 10 cm; 18 of 40) or multifocal (six), usually high grade (25), and frequently proximal or involving neurovascular structures such that limb salvage was precluded. Median range age of the patients was 59 (17–87) years. The operative 30-day mortality rate was zero. Hospital stay was a median of 10·5 days for forequarter amputation, and 19 days for hindquarter and through-hip amputation. Local recurrence occurred in ten patients, six of whom had concurrent distant metastases. Twenty-seven patients were alive (20 disease free) at a median follow-up of 12 months, nine of whom were alive without evidence of disease beyond 2 years. Ten patients died after a median of 7·5 months; three survived more than 2 years. Conclusion Major amputation is a useful procedure in carefully selected patients with soft-tissue sarcoma.
Neurovascular bundle
Hemipelvectomy
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Hemipelvectomy
Adjuvant Therapy
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Soft tissue sarcomas are a heterogeneous group of neoplasms that arise throughout the body, but most commonly in the extremity and trunk. A multidisciplinary treatment approach has resulted in local control rates exceeding 90% and 5-year survival rates exceeding 70%. For patients with localized soft tissue sarcoma, limb-sparing surgical resection is the mainstay of therapy, with radiation therapy and chemotherapy used as adjuncts to reduce local and distant recurrences. Amputation is reserved for patients with primary or recurrent tumors that cannot be grossly resected with a limb-sparing procedure and preservation of function, which should occur in less than 5% of patients. Most patients who die of soft tissue sarcoma die of metastatic disease, which becomes evident within 2 to 3 years of initial diagnosis in 80% of cases, highlighting the need for improved systemic therapy options and optimal treatment at the time of diagnosis. This review contains 13 figures, 4 tables and 53 references Key words: amputation, multimodality, radiation therapy, soft tissue sarcoma, staging, surgery, treatment, wide resection
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Purpose: Patients who were diagnosed with soft tissue sarcoma (STS) of limbs and met the indications for amputation because of no effective soft tissue coverage after extensive tumor resection were treated with skin flap transplantation and therapeutic courses were observed.
Methods: A total of 23 patients, pathologically diagnosed as soft tissue sarcoma from January 2011 to June 2015 and whose effective soft tissue coverage was not guaranteed due to extensive tumor resections were included. They underwent extensive tumor excision and skin flap grafting. The postoperative follow-up, tumor control and functional recovery was evaluated as per the Musculoskeletal Tumor Society (MSTS) score.
Results: The follow-up time was from 8 to 60 months, with an average follow-up of 39.69 months. Of the 23 patients, 10(43.47%) died of tumor metastasis from 8th to 23rd months after surgery. In these 10 cases, 2 cases (8.70%) subsequently underwent amputation because of local tumor recurrence. The remaining 13 patients are recurrence free till date of follow up. The MSTS limb function score at 3 months after surgery of all patients were 7-28 points, with an average of 22.56 points, and the excellent and fair scores are observed in 91.30% of patients.
Conclusion: For patients who cannot achieve effective soft tissue coverage after extensive resection of soft tissue sarcoma and meet the indications of amputation can have limb preservation by extensive tumor resection combined with skin flap transplantation with a good functional results
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The results of surgical treatment of 297 soft tissue sarcomas arising in the lower extremity were critically examined. En bloc wide soft part resection (158 cases) yielded five and ten year survival rates of 63% and 50%. Amputation or major disarticulation (139 cases) gave corresponding survival rates of 45% and 29%. The most frequent cause of treatment failure was distant metastases, commonly in the lungs. The tissue type of sarcoma, histologic grade of malignancy, and tumor size appear to be important determinants of survival irrespective of the type of surgical treatment. Local recurrence of sarcoma occurred in 18% of the cases, more commonly after soft part resections than amputations. The proximity of a sarcoma to major vessels, bone or joint tends to compromise the margins of a wide soft part resection, thus increasing the risk of local recurrence. In appropriate cases, the scope of soft part resection can be extended by en bloc excision of the femoral vessels, with the hope of improving local control of sarcoma. Amputation should br resorted to if an adequate margin of resection cannot otherwise be obtained. This decision must be weighted against the high frequency of distant metastases in this disease. Postoperative adjuvant chemotherapy and immunotherapy offer prospects of prevention of this tragic outcome.
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Epithelioid sarcoma
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Bone Sarcoma
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Objectice:To study the relationship of surgical trteatment, pathological stages and prognosis of soft tissue sarcoma In extremities. Methods:31 cases of soft tissue sarcoma in extremities in different pathological stages were reviewed. 22 cases were treated with wide excision and 9 cases were treated with amputation. Results:Among 22 cases treated with wide excision,16 cases were in gradeⅠ,11 cases had survived for 5 to 15 years without relapse and 3 cases had local recurrence. In 9 cases treated with amputation,3 cases died of lung metastasis within 18 months,6 cases survived for 4 to 15 years without relapse. Conclusion:The prognosis of soft tissue sarcoma in extremities in gradeⅠwith wide excision is better than that in grade Ⅲ or Ⅳ, if the local wide excision for patients with grade Ⅲ or Ⅳ is not good,the amputation or disarticulation is recommended.The extent of local resection should be wide enough or radical,and adjuvant radiotherapy is advisable.
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Wide local excision
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