August 11, 2009

Saving Limbs May Not Be Better Than Amputation

A new analysis suggests patients and physicians should rethink the pros and cons of limb-sparing surgery versus amputation for bone and soft tissue sarcomas of the lower limb.

Patients with tumors of the bone or soft tissue in their arms and legs require surgery to remove their cancer. To compare the costs and benefits of amputation compared with limb-sparing surgery in these patients, Canadian researchers Ronald Barr, M.D., M.B., Ch.B., of McMaster University and Jay Wunder, M.D., M.Sc., of the Mount Sinai Hospital and the University of Toronto, reviewed all published papers that examined limb-sparing surgery and also measured patients' functional health and quality of life.

Their review found while limb-sparing surgery is generally as effective as amputation in ridding the patient of cancer, it tends to be associated with more complications. Surprisingly, these studies also show limb salvage does not provide a better quality of life for patients than amputation, particularly for patients with lower limb bone sarcomas.

Most studies found the differences in disability between patients who underwent amputation and those who had limb-sparing surgery are smaller than expected. In fact, many revealed no significant difference in psychological health and quality of life. However, there do appear to be greater advantages to limb-sparing surgery over amputation for surgical sites, such as the hip, that are located higher on the lower limb.

Some studies looked at the costs of amputation versus limb-sparing surgery. 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 thorough comparison of amputation and limb-sparing surgery in different types of patients with bone and soft tissue sarcomas. Dr. Wunder was quoted as saying, "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."

SOURCE: Cancer, September 15, 2009