Contemporary role of amputation for patients with extremity soft tissue sarcoma |
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| Affiliation: | 1. Department of Surgery - ASST Sette Laghi, Varese, Italy;2. Department of Surgery, Patel Hospital, Karachi, Pakistan;3. European School of Soft Tissue Sarcoma Surgery, ESSO, Brussels, Belgium;4. Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy;5. Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital Birmingham, UK;6. Clinical Epidemiology and Trial Organization, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy;7. Department of Orthopedic Surgery, ASST Monza Ospedale San Gerardo, Italy;1. Department of cancer medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy;2. Department of Orthopaedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany;3. Department of Pathology, Harvard Medical School, Brigham and Women’s Hospital, Boston, USA;4. Department of Radiology, Technische Universität München, Munich, Germany;5. Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, the Netherlands;6. Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;7. High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy;8. Department of Medical Oncology, Homi Bhabha National Institute, Mumbai, India;9. Department of Medical Oncology, Hospital of Prato, Prato, Italy;10. Department of Orthopaedic Surgery, UCLA, Los Angeles, USA;11. Department of Medical Oncology, Université Centre Léon Bérard, Lyon, France;12. Department of Medical Oncology, Oslo University Hospital, Oslo, Norway;13. Oncology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain;14. Department of Medical Oncology, National Taiwan University Hospital and Cancer Center, Taiwan;15. Department of Pathology, University of Padua, Padua, Italy;p. Peter MacCallum Cancer Centre/Royal Melbourne Hospital, Melbourne, Australia;q. Patient representative, Germany;r. Department of Medical Oncology, LUCC - Lund University Cancer Centre, Lund, Sweden;s. Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy;t. Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands;u. Department of Orthopaedic Oncology, Uniklinik Essen, Essen, Germany;v. Gerhard-Domagk-Institute for Pathology, Uniklinik Münster, Münster, Germany;w. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, USA;x. Department of Medical Oncology, Institut Bergonié, Bordeaux, France;y. Sarcoma Unit, The Royal Marsden, London, United Kingdom;z. Department of Muscoloskeletal Oncology, National Cancer Center Hospital (NCCH), Tokyo, Japan;11. Department of Orthopaedics and Trauma, Medizinische Universität Graz, Graz, Austria;22. Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong;33. Department of Paediatric Orthopaedic Surgery, Clinique Arago, Paris, France;44. Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy;55. Patient representative, Germany;66. Department of Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;77. Department of Medical Oncology, MD Anderson Cancer Center, Houston, USA;88. Department of Medical Oncology, Helios Klinikum Berlin-Buch, Berlin, Germany;99. Robert J. Tomsich Pathology and Laboratory Medicine Institute and Department of Cancer Biology, Cleveland Clinic, Cleveland, USA;1010. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland;1111. Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy;1212. Sarcoma Patient Advocacy Global Network (SPAGN), Germany;1313. Department of Oncology, University College Hospital London, London, United Kingdom;1414. Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;1515. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, USA;pp. Department of Pathology, Stanford University, Stanford, USA;qq. Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands;rr. Department of Radiology, Universities of Antwerp and Gent, Gent, Belgium;ss. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA;tt. Patient Representative, Life Raft Group, and Pharmacokinetics, University of Maryland Baltimore, USA;uu. Department of Orthopedic Surgery, Leiden University Medical Centre, Leiden, the Netherlands;vv. Department of Medical Oncology, Sarcoma Center, Uniklinik Essen, Essen, Germany;15. Elisabeth-Tweesteden Ziekenhuis, Tilburg, the Netherlands;p. Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands;q. Radboud University Medical Center, Nijmegen, the Netherlands;r. Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom;1. Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands;2. Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands;3. Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands;4. Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands;5. Cancer Center Amsterdam, Amsterdam, the Netherlands;6. Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;7. Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands;8. Department of Surgery, ZGT Hospital Group, Almelo, the Netherlands;9. Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom;10. Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands;11. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands;12. Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands;13. Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands;14. Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands;1. CUAMM Medical Doctors with Africa, Kampala, Uganda;2. Matany Saint Kizito Hospital, Moroto, Uganda;3. Hepatobiliary Surgery Unit, Foundation ‘‘Policlinico Universitario A. Gemelli’‘, IRCCS, Catholic University, Rome, Italy;4. Department of Women and Children''s Health, Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy;1. Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA;2. University of Illinois College of Medicine, Chicago, Illinois, USA;3. Musculoskeletal Oncology Division, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA;1. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia;2. Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia;3. Department of Surgery, Cork University Hospital, Wilton Road, Cork, Ireland;1. Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands;2. Department of Medical Oncology, ErasmusMC Cancer Institute, Erasmus Medical Center, Rotterdam, the Netherlands;3. Department of Surgical Oncology, ErasmusMC Cancer Institute, Erasmus Medical Center Rotterdam, the Netherlands;4. Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom;5. Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands;6. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands |
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| Abstract: | Introductionlimb-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 methodsconsecutive 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.ResultsAmong 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.ConclusionContemporary 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. |
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| Keywords: | Extremity soft tissue sarcoma Amputation Limb-sparing surgery Survival Frailty |
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