Long‐term patient‐reported outcome measures following limb salvage with complex reconstruction or amputation in the treatment of upper extremity sarcoma

Abstract

Background and Objectives This study compares long‐term patient‐reported outcomes between patients that underwent limb‐salvage surgery with complex reconstruction by free or pedicled flap (LS) or amputation. Additionally, the need for revision surgery is compared. Methods A total of 43 patients were studied at a median follow‐up of 9.54 years. Sixteen patients completed questionnaires regarding functional outcome and mental wellbeing. Functional outcomes were measured by using the Toronto Extremity Salvage Score (TESS), QuickDASH, and PROMIS Upper Extremity instruments. Mental wellbeing was assessed using the PROMIS Anxiety and Depression instruments. Revision surgery was assessed for the entire follow‐up. Results The median TESS scores were 96.0 versus 71.7 (p = 0.034) and the PROMIS Upper Extremity scores were 50.1 versus 40.3 (p = 0.039) for the LS and amputation cohorts, respectively. No significant difference was found regarding symptoms of anxiety (52.7 vs. 53.8; p = 0.587) or depression (52.0 vs. 50.5; p = 0.745). Of the patients in the LS cohort 51.6% required at least one reoperation compared to 8.33% in the amputation cohort. Conclusions LS surgery maintains functional benefits over amputation after almost a decade of follow‐up. Still, mental wellbeing seems to be comparable between these patients, whereas LS procedures are associated with a sixfold increased need for reoperations.

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 ).…”

“…Using a cohort of 43 sarcoma patients, Yannick et al. ( 10 ) reported comparable mental wellbeing between patients with LSS and those receiving amputation, although the functional benefits of LSS over amputation were maintained at nearly 10 years of follow-up. However, we could not evaluate the impact of LSS on the quality of life in these patients in detail using data from the SEER program.…”

“…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 ).…”

“…Previous studies on the use of limb salvage among patients with EBST sarcomas were limited by small sample sizes and data collected mostly at single institutions ( 10 , 14 , 17 , 18 ). There are few retrospective studies with results to inform clinical practice.…”

Precision of Dynamic Infrared Thermography in Anterolateral Thigh Flap Planning: Identification of the Perforator Fascia Passage

“…1 2 Furthermore, they contributed to the improvement in quality of life of sarcoma patients, as limbs that previously required amputation could now be salvaged. 3 The anterolateral thigh (ALT) flap is a well-established soft tissue perforator flap usually supplied by the descending branch of the lateral circumflex femoral vessels. 4 Compared with the anteromedial thigh flap, it is thinner and the harvesting process is straightforward.…”