Major amputation for soft‐tissue sarcoma

Background: Advances in oncological practice have reduced the number of major amputations performed for soft‐tissue sarcoma, but this remains a valuable, if infrequent, option for both curative and palliative indications. Methods: A review of patients and case‐notes was carried out from the prospective sarcoma database at the Royal Marsden Hospital. Results: Over a 10‐year interval, 40 major amputations (18 forequarter, 17 hindquarter and five through hip) were performed, predominantly for disease recurring after previous limb‐conserving surgery (31 of 40). A wide variety of soft‐tissue sarcoma subtypes was seen; they were often large (more than 10 cm; 18 of 40) or multifocal (six), usually high grade (25), and frequently proximal or involving neurovascular structures such that limb salvage was precluded. Median range age of the patients was 59 (17–87) years. The operative 30‐day mortality rate was zero. Hospital stay was a median of 10·5 days for forequarter amputation, and 19 days for hindquarter and through‐hip amputation. Local recurrence occurred in ten patients, six of whom had concurrent distant metastases. Twenty‐seven patients were alive (20 disease free) at a median follow‐up of 12 months, nine of whom were alive without evidence of disease beyond 2 years. Ten patients died after a median of 7·5 months; three survived more than 2 years. Conclusion: Major amputation is a useful procedure in carefully selected patients with soft‐tissue sarcoma. Copyright © 2002 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd