Limb-Sparing Surgery May Not Provide Better Quality of Life Than Amputation

Limb-sparing surgery, which has steadily been replacing amputation for bone and soft tissue sarcomas of the lower limb, may not provide much or even any additional benefit to patients, according to a new study.

Researchers at McMaster University (Hamilton, ON, Canada) and Mount Sinai Hospital (Toronto, ON, Canada) reviewed all published papers on limb-sparing surgery that also measured patients' functional health and quality of life (QOL), and compared the costs and benefits of amputation to limb-sparing surgery. The researchers found that while limb-sparing surgery is generally as effective as amputation in ridding the patient of cancer, it tends to be associated with increased early and late complications. The researchers also found that limb salvage does not provide a better QOL to patients than amputation, particularly for those patients with lower limb bone sarcomas.

Many studies revealed no significant differences in psychological health and QOL between patients who underwent amputations and those who had limb-sparing surgery, and most studies found that the differences in disability between amputation and limb-sparing patients were smaller than expected. The review did find, however, that there appear to be greater advantages to limb-sparing surgery over amputation for higher surgical sites in the lower limb, such as the hip. Conversely, amputation carries longer-term costs related to artificial limb manufacture, maintenance, and replacement. The researchers added that additional studies are needed to provide a thorough comparison of amputation and limb-sparing surgery in different types of patients with bone and soft tissue sarcomas. The study was published ahead of print on August 10, 2009, in the online edition of Cancer.

"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 coauthor Jay Wunder, M.D., M.Sc. of Mount Sinai Hospital.

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McMaster University
Mount Sinai Hospital