Complications, mobility, and quality of life in ankle sarcoma patients

Abstract

Aims The aims of the study were to analyze differences in surgical and oncological outcomes, as well as quality of life (QoL) and function in patients with ankle sarcomas undergoing three forms of surgical treatment, minor or major limb salvage surgery (LSS), or amputation. Methods A total of 69 patients with ankle sarcomas, treated between 1981 and 2017 at two tumour centres, were retrospectively reviewed (mean age at surgery: 46.3 years (SD 22.0); 31 females (45%)). Among these 69 patients 25 were analyzed prospectively (mean age at latest follow-up: 61.2 years (SD 20.7); 11 females (44%)), and assessed for mobility using the Prosthetic Limb Users Survey of Mobility (PLUS-M; for amputees only), the Toronto Extremity Salvage Score (TESS), and the University of California, Los Angeles (UCLA) Activity Score. Individual QoL was evaluated in these 25 patients using the five-level EuroQol five-dimension (EQ-5D-5L) and Fragebogen zur Lebenszufriedenheit/Questions on Life Satisfaction (FLZ). Results Of the total number of patients in the study, 22 (32%) underwent minor LSS and 22 (32%) underwent major LSS; 25 underwent primary amputation (36%). Complications developed in 26 (38%) patients, and were more common in those with major or minor LSS in comparison to amputation (59% vs 36% vs 20%; p = 0.022). A time-dependent trend towards higher complication risk following any LSS was present (relative risk: 0.204; 95% confidence interval (CI) 0.026 to 1.614; p = 0.095). In the prospective cohort, mean TESS was higher following minor LSS in comparison to amputation (91.0 vs 67.3; p = 0.006), while there was no statistically significant difference between major LSS and amputation (81.6 vs 67.3; p = 0.099). There was no difference in mean UCLA (p = 0.334) between the three groups (p = 0.334). None of the items in FLZ or EQ-5D-5L were different between the three groups (all p > 0.05), except for FLZ item “self-relation”, being lower in amputees. Conclusion Complications are common following LSS for ankle sarcomas. QoL is comparable between patients with LSS or amputation, despite better mobility scores for patients following minor LSS. We conclude that these results allow a decision for amputation to be made more easily in patients particularly where the principles of oncological surgery would otherwise be at risk. Cite this article: Bone Joint J 2021;103-B(3):553–561.

Postoperative clinical and functional outcomes in patients with tumor and tumor‐like lesion of foot and ankle

“…In this study, as in previous reports, 20% of patients with malignant or intermediate malignancy had died from diseases, and 53% had undergone amputation. Usually, to fulfill the oncological goal of treatment, wide resection and reconstruction are warranted; however, when complete resection of the tumor is difficult or there is a high risk of local recurrence after resection, amputation of the foot or the leg is recommended [26]. Malignant bone tumors of the forefoot should be treated locally with amputation at a level appropriate for the proximal extension of the tumor [27]; accordingly, in three of our cases, amputations at the metatarsal and metatarsophalangeal disarticulation were performed in the first surgery, and neither of 4 The change rate of comparison between bone and soft tissue lesions using the JSSF scale from preoperative to postoperative in each subcategory (a) and total scale (b).…”

Impact of Limb Salvage on Prognosis of Patients Diagnosed With Extremity Bone and Soft Tissue Sarcomas

“…Several small samples or single-center clinical cohort studies have shown that LSS had a better prognosis than amputation among patients with EBST sarcomas ( 13 , 29 ). In addition to the postoperative survival rate, clinicians are increasingly concerned about the higher recurrence rate and complications caused by limb salvage procedures, as these are associated with a poorer prognosis ( 9 , 10 , 30 ). Some studies have reported no significant difference in the incidence of local recurrence of sarcoma among patients who underwent LSS and amputation ( 8 , 29 ).…”

“…Despite the conventional wisdom that radical surgery reduces recurrence rate and complications ( 8 ), limb salvage surgery (LSS) has become increasingly attractive to orthopedists and patients with EBST sarcomas because of the minimal impairment to physical appearance and function. However, there remained a question as to whether LSS has a detrimental effect on the survival of sarcoma patients ( 9 , 10 ). In a comparative study encompassing 1,220 patients with osteosarcoma treated with neoadjuvant chemotherapy, 36% and 20% of patients developed local recurrence following limb salvage with intralesional margins and marginal margins, respectively, but no events were observed among patients receiving amputation ( 11 ).…”

What’s New in Musculoskeletal Tumor Surgery

“…Intercalary resection (when possible) or ankle arthrodesis provided the most reliable functional outcome over osteoarticular reconstructions. In looking specifically at ankle sarcomas, Smolle et al found similar quality of life and activity between patients who underwent limb salvage and those who underwent amputation, and a higher risk of complications with limb salvage 14 . These data suggest that, in cases that require more than minor procedures for limb salvage, amputation provides equivalent outcomes and lower complications.…”