Limb Salvage Versus Amputation in Conventional Appendicular Osteosarcoma: a Systematic Review

Abstract

The overall survivorship in patients with appendicular osteosarcoma has increased in the past few decades. However, controversies and questions about performing an amputation or a limb salvage procedure still remain. Using three peer-reviewed library databases, a systematic review of the literature was performed to evaluate all studies that have evaluated the outcomes of appendicular osteosarcoma, either with limb salvage or amputation. The mean 5-year overall survivorship was 62% for salvage and 58% for amputation ( > 0.05). At mean 6-year follow-up, the local recurrence rates were 8.2% for salvage and 3.0% for amputation ( > 0.05). Additionally, at mean 6-year follow-up, the rate for metastasis was 33% for salvage and 38% for amputation ( > 0.05). The revision rates were higher with salvage (31 vs. 28%), and there were more complications in the salvage groups (52 vs. 34%; > 0.05). Despite the heterogeneity of studies available for review, we observed similar survival rates between the two procedures. Although there was no significant statistical difference between rates of recurrence and metastasis, the local recurrence rate and risk of complications were higher for limb salvage as compared to amputation. Cosmetic satisfaction is often higher with limb salvage, whereas long-term expense is higher with amputation. Overall, current literature supports limb salvage procedures when wide surgical margins can be achieved while still retaining a functional limb.

Limb-salvage surgery offers better five-year survival rate than amputation in patients with limb osteosarcoma treated with neoadjuvant chemotherapy. A systematic review and meta-analysis

“…A recent systematic review [29] reported similar survival rates between the two procedures, but higher local recurrence rates for LSS as compared to amputation (8.2% versus 3.0%) [29] . Local recurrence is expected to be higher in LSS group as a general rule as the margins in an amputation will usually be radical.…”

A propensity‐score matched analysis of limb salvage vs amputation for osteosarcoma

“…However, due to the low incidence of osteosarcoma among the general population, these studies are limited by small sample sizes. Larger database reviews and meta‐analyses have yielded mixed results due in part to the heterogeneity of studies available for review and surgeon selection bias that continues to play a significant role in affecting these conclusions …”

Extreme bone lengthening by bone transport with a unifocal tibial corticotomy: a case report

“…Despite the long treatment period and the suboptimal outcome obtained, the patient preferred a limb salvage approach to an amputation and is satisfied with the final result. Furthermore, the total cost of limb salvage is lower than that of amputation [26]. The success of the procedure described in the present case report was a result of the cooperation of the patient and his strong desire to preserve the injured limb as well as the follow-up performed.…”