Psychological outcome of extremity sarcoma survivors undergoing amputation or limb salvage.

Abstract

When compared to amputation, limb salvage procedures for extremity sarcomas have been advocated because of potential functional benefits and presumed psychological-outcome advantages. The purpose of this study was to compare psychological outcomes between survivors who underwent either amputation or limb salvage procedures for extremity sarcomas. Fifteen amputees and 20 patients with salvaged limbs (mean age, 37.9 years; range, 15 to 71 years) were evaluated 1 to 5 years after surgery for extremity sarcomas. Demographic and medical information was obtained and cognitive functioning, affect, mood, body image, physical functioning, global psychological adjustment to illness and surgery, and lifetime prevalence of psychiatric disorders before and after surgery were assessed. Two patients were excluded because of the presence of an incapacitating organic mental syndrome. The remaining patients, 14 amputees and 19 patients with salvaged limbs, had a variety of soft-tissue and bone sarcomas. No significant differences were found between the groups in age, sex, marital status, surgically involved extremity, chemotherapy status, and social class at the time of surgery and interviews. There were no significant differences between the groups in scores of cognitive capacity, symptoms, mood, body image changes, global physical functioning, global adjustment to illness and surgery, and lifetime prevalence of psychiatric disorders before or after surgery. Most patients revealed only mild psychological symptoms and 55% demonstrated good to excellent adjustment to their surgeries and diseases. There were no significant differences in measures of psychological outcome for patients with extremity sarcomas who underwent limb salvage procedures compared to those who underwent amputation. A psychological-outcome advantage of limb-salvage surgery compared to amputation has yet to be demonstrated.

Prosthetic replacement surgery for bone tumours – cure at less cost?

“…Indeed the only significant findings in the study were that, when compared with limb salvage patients, amputees were both better emotionally adjusted and had superior 'body care and movement' as well as having better scores for 'health care orientation' and 'sexular relationships'. A similar result was also found by Weddington et al (1985). An additional approach which can be studied when assessing functional outcome is to measure the energy cost of gait.…”

Quality of Life Implications as a Consequence of Surgery: Limb Salvage, Primary and Secondary Amputation

“…Differences in physical functioning were reported by Rougraff et al 7,8 , with better outcomes for patients treated with LSS, but no differences in psychological outcomes have been found 7,8,9,10 . Patients treated for a bone tumour with LSS have reported poorer QoL compared with the normal population 11 .…”

What is the Emotional Acceptance After Limb Salvage with an Expandable Prosthesis?

“…quality of life with limb salvage has been reported due to less social alienation and increased self-esteem compared to amputations [20,24,30]. In contrast, some authors report equivalent quality of life in limb salvage and amputation patients [22,23,26,34,36].…”