How much is a leg worth following radical tumor resection in bone sarcomas? Literature review

• Published in: Surgical oncology Vol. 46; p. 101900
• Main Authors: Tóth, László, Krieg, Andreas H., Nowakowski, Andrej M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2023
• Subjects: Adolescent; Amputation; Bone Neoplasms - pathology; Bone Neoplasms - surgery; Humans; Leg - pathology; Leg - surgery; Limb Salvage - adverse effects; Limb salvage surgery; Long-term outcome; Lower extremity; Lower Extremity - pathology; Osteosarcoma; Osteosarcoma - surgery; Quality of Life; Retrospective Studies; Sarcoma - surgery; Treatment Outcome; Young Adult; Lower extremity; Limb salvage surgery; Long-term outcome; Osteosarcoma; Amputation; Quality of life
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2022.101900

Bone sarcomas of the lower extremities are rare malignancies occurring mostly amongst adolescents and young adults. Necessarily, the therapy conducted in sarcoma centers is multimodal and multidisciplinary. In certain cases, in a metastasis free situation with adequate therapy, an overall survival rate of 90% can be achieved. Two principal surgical procedures exit for the local control of the malignancy: 1. Limb salvage with biological with/or endoprosthetic reconstruction; and, 2. amputation with restoration of the function with exoprosthesis or endo-exoprosthesis. Currently, limb salvage procedures are performed in up to 95% of cases. In contrast, amputation is performed when the disease has reached an advanced stage or limb salvage has failed. Both of the surgical options have their risks and possible complications. According to the literature, there should be no significant difference between limb salvage and amputation with respect to long-term overall survival, overall quality of life, psycho-socio-economic outcomes, or patient satisfaction. An important advantage of limb salvage is greater everyday functionality. With the expanded indication of limb salvage and great survival rates, the cases of late complications in patients expecting to maintain their own leg continues to increase. In some cases, it requires multiple interventions, ranging from minor up to the most complex revisions, to maintain the functionality of the extremity. Despite the great costs, personal effort, and the possible complications, limb salvage could be a suitable method to achieve functionally beneficial outcomes and patient satisfaction in bone sarcomas of the lower extremities over the long-term even in cases involving complications. •Potential for limb salvage in sarcomas of lower extremity has expanded.•Limb salvage can achieve a beneficial functionality and patient satisfaction.•Limb salvage implies great costs, personal effort, and possibility of complications.•Multiple revisions are expected to maintain the functionality of the extremity.