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Palliative amputation has a place in metastatic sarcoma

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Patients with stage IV sarcoma may benefit from palliative amputation (PA) when they have intractable pain, fungating tumors, or symptoms that diminish quality of life, according to a study.

PA is not often performed due to the morbidity associated with amputation and the limited life expectancy of these patients.

Researchers retrospectively reviewed the cases of 26 patients who underwent PA (11 for carcinoma, 15 for sarcoma). Pain was indicated for all patients and fungating tumors in 16 patients. The PA was the initial surgery in 7 patients. The most common procedure was forequarter amputations, which was performed on 6 patients.

Pain, measured with the mean (±standard deviation) visual analog pain score (on a 10-point scale), decreased in all patients, going from a preoperative of 5.7 ± 2.9 to a postoperative score of 0.43 ± 1.3 (P < 0.001). The mean ECOG score was 1.9 ± 0.2 preoperatively compared with 1.3 ± 0.1 postoperatively (P < 0.001). Six patients with upper extremity amputation and 8 patients with lower extremity amputations were fitted for prostheses.

Within 6 months of the procedure, 2 patients had local recurrence.

The mean survival time after PA was 13±12 months, and mean follow-up was 28±29 months.

Adjuvant chemotherapy was positively associated with survival.

LiBrizzi CL, Levin AS, Strike SA, et al. Indications and outcomes of palliative major amputation in patients with metastatic cancer. Surg Oncol. 2021;40:101700. doi: 10.1016/j.suronc.2021.101700. Epub ahead of print. PMID: 34992030.