McMaster University

McMaster University

Faculty of
Health Sciences

Limb-sparing surgery may not be better than amputation for bone cancer patients

By Suzanne Morrison
Published: August 10, 2009
Ronald Barr
Dr. Ronald Barr, a professor of pediatrics, pathology and medicine of the Michael G. DeGroote School of Medicine

Limb-sparing surgery is replacing amputation as the treatment of choice for cancers of bone and soft tissue in the lower limbs, but a McMaster University researcher has found the newer procedure offers patients little additional benefit.

Cancer specialist Dr. Ronald Barr, a professor of pediatrics, pathology and medicine of the Michael G. DeGroote School of Medicine, undertook an extensive review of all published papers on limb-sparing surgery that also measured patients’ functional status and health-related quality of life, with Dr. Jay Wunder, an orthopedic surgical oncologist at Toronto’s Mount Sinai Hospital.

Their analysis, "Bone and Soft Tissue Sarcomas are often Curable — But at What Cost?" is published in the Sept. 15 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

The authors conclude it "cannot be assumed" limb salvage surgery will offer a better functional outcome and health-related quality of life than amputation for young people with bone and soft tissue sarcomas of the lower limb.

"While the surgical and bio-engineering techniques employed in limb conservation continue to improve, it remains important to assess the outcome of these procedures from the perspective of the patient," said Dr. Barr.

Soft tissue sarcomas are cancers that develop from cells in the soft, supporting tissues of the body. Almost half occur in limbs — especially the legs. The goal of limb-sparing surgery is the safe and complete removal of a tumour while preserving limb function.

The current review found that limb-sparing surgery is generally as effective as amputation in ridding the patient of cancer, but it tends to be associated with more early and late complications.

Surprisingly, studies also show that, particularly for patients with bone sarcomas of the leg, limb salvage does not provide a better quality of life than amputation. 

Most studies have found the differences in disability following amputation and limb-sparing surgery are smaller than expected.  Many revealed no significant differences in psychological health and quality of life between patients who underwent amputations and those who had limb-sparing procedures.

However, there appears to be greater advantages to limb-sparing surgery over amputation for higher surgical sites in the lower limb, such as the hip.

Studies showed "up front" surgical costs, the duration of rehabilitation, and the need for revisions are all greater for limb-sparing surgery.  However, amputation carries longer term costs related to artificial limb manufacture, maintenance and replacement.

The authors say additional research is needed to provide a through comparison of amputation and limb-sparing surgery in different types of patients with bone and soft tissue sarcomas. "Future studies that include function, health-related quality of life, economics and stratification of patients by age will be useful contributions to decision-making by patients, health care providers and administrators," said Wunder.

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