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The Indications for and the Prognostic Significance of Amputation as the Primary Surgical Procedure for Localized Soft Tissue Sarcoma of the Extremity

¹ University Musculoskeletal Oncology Unit, Mount Sinai Hospital, 600 University Avenue, Suite 476E, Toronto, Ontario M5G 1X5, Canada
² Research, Toronto Rehabilitation Institute, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada
³ Department of Diagnostic Imaging, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
⁴ Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
⁵ Sarcoma Site Group, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada

Correspondence: Address correspondence and reprint requests to: Jay S. Wunder, MD, MSc, FRCSC; E-mail: wunder{at}mshri.on.ca

Background: The indications for primary amputation of a localized soft tissue sarcoma (STS) of the extremity are not well defined in the literature. However, it has been suggested that patients who require an amputation to treat an STS are at increased risk for developing metastases. We categorized the main indications for primary amputation in our patient population and compared their oncological outcome with the outcome of patients who underwent limb-sparing surgery.

Methods: 413 consecutive patients treated surgically at a single center for primary, non-metastatic, deep, intermediate-, or high-grade STS of the extremity were reviewed. Indications for primary amputation were identified. Demographics and outcomes were compared between the amputation and limb-salvage groups. Multivariate Cox model analysis was used to identify independent risk factors for systemic relapse.

Results: Twenty-five (6%) of 413 patients with STS underwent primary amputation: they were older (P = .05), had larger tumors (P = .001), and had a significantly greater risk of developing metastatic disease than patients who underwent limb-sparing procedures (P = .008). However, multivariate analysis demonstrated that the only independent predictors of systemic relapse were tumor size (P = .0001) and tumor grade (P = .0001). Primary amputation was not an independent risk factor for metastatic disease.

Conclusions: The decision to perform a primary amputation for an STS of the extremity is based on the location and local extent of the tumor, and the expected function of the extremity after tumor resection. The higher risk of metastases for patients who require primary amputation is accounted for by independent risk factors associated with their tumors—predominantly large tumor size.

Key Words: Amputation • Soft-tissue sarcoma • Indications • Prognosis • Metastasis

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