1st on the web (August 11, 2009)
Limb-sparing surgery, an alternative to amputation for bone and soft tissue sarcomas of the lower limb, may not provide much or even any additional benefit to patients compared to amputation, according to a new review.
Researchers who conducted the analysis, which was posted yesterday in the online edition of Cancer, recommend that patients and physicians should rethink the pros and cons of both limb-sparing surgery and amputation before making a final decision.
To compare the costs and benefits of limb-sparing surgery with amputation in these patients with cancer, researchers Ronald Barr, MD, MB, ChB, of McMaster University in Hamilton, Ontario, and Jay Wunder, MD, MSc, of Mount Sinai Hospital and the University of Toronto, reviewed all published papers on limb-sparing surgery that also measured patients’ functional health and quality of life.
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According to a press release, the researchers found that while limb-sparing surgery is generally as effective as amputation in removing the patient’s cancer, it tends to be associated with more early and late complications. Studies also show that, particularly for patients with lower limb bone sarcomas, limb salvage does not provide a better quality of life to patients than amputation, according to the press release.
In the press release, Wunder said most studies have found that the differences in disability between amputation and limb-sparing patients are smaller than expected. Many revealed no significant differences in psychological health and quality of life between patients who underwent amputations and those who had limb-sparing surgery. However, there appear to be greater advantages to limb-sparing surgery over amputation for higher surgical sites in the lower limb, such as the hip.
Some studies have compared the costs of amputation vs. limb-sparing surgery. “Up front” surgical costs, the duration of rehabilitation and the need for revisions are all greater for limb-sparing surgery. However, amputation carries greater longer-term costs related to artificial limb manufacture, maintenance and replacement, the researchers said in the press release.
The authors say additional research is needed to provide a thorough comparison of amputation and limb-sparing surgery in different types of patients with bone and soft tissue sarcomas.
“Future studies that include function, health-related quality of life, economics and stratification of patients by age will be useful contributions to decision-making … by patients, health care providers and administrators,” Wunder said in the press release.
Reference:
- Barr R, Wunder J. Bone and soft tissue sarcomas are often curable – But at what cost? A call to arms (and legs). Cancer. Advance preview published on Aug. 10. 10.1002/cncr.24458.
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