Health-related quality of life after isolated limb perfusion compared to extended resection, or amputation for locally advanced extremity sarcoma: Is a limb salvage strategy worth the effort?

• Published in: European journal of surgical oncology Vol. 48; no. 3; pp. 500 - 507
• Main Authors: Reijers, Sophie J.M., Husson, Olga, Soomers, Vicky L.M.N., Been, Lukas B., Bonenkamp, Johannes J., van de Sande, Michiel A.J., Verhoef, Cornelis, van der Graaf, Winette T.A., van Houdt, Winan J.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2022
• Subjects: Amputation; Cross-Sectional Studies; Follow-Up Studies; Humans; Isolated limb perfusion; Limb Salvage - methods; Lower Extremity - surgery; Neoplasms, Second Primary - surgery; Perfusion; Quality of Life; Sarcoma - surgery; Soft Tissue Neoplasms - surgery; Soft tissue sarcoma; Treatment Outcome; Soft tissue sarcoma; Amputation; Quality of life; Isolated limb perfusion
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2021.08.007

The aim of this study was to compare long-term patient reported outcomes (PROs) in patients with locally advanced extremity soft tissue sarcoma (eSTS) after isolated limb perfusion followed by resection (IR), compared to extended resection (ER), primary amputation (A) or secondary amputation after IR (IR-A). Patients were selected from the respondents of a multi-institutional cross-sectional cohort survivorship study (SURVSARC) conducted among sarcoma survivors registered in the Netherlands Cancer Registry (NCR), 2–10 years after diagnosis. Used PROs were the EORTC QLQ-C30, the Cancer worry scale (CWS), the Hospital Anxiety and Depression Scale (HADS), and the Toronto Extremity Salvage Score (TESS). We identified 97 eSTS survivors: IR = 20, ER = 49, A = 20, IR-A = 8. While there were no differences in PROs between IR and ER, results showed better functioning and functionality in both groups versus the amputation groups. The amputation groups scored significantly lower on physical functioning (A = 62.7, IR-A = 65.7 versus IR = 78.0, ER = 82.7, p = 0.001) and role functioning (A = 67.5, IR-A = 52.8 versus IR = 79.2, ER = 80.6, p = 0.039), both EORTC QLQ-C30 scales. Also for the TESS, the scores were significantly lower for the amputation groups compared to the limb sparing groups (upper extremity p = 0.007 with A = 68.9, IR-A = 71.6 versus IR = 93.3, ER = 91.1; lower extremity p < 0.001 with A = 72.2, IR-A50.9 versus IR = 84.5 and ER = 85.5). There were no significant differences between the groups on cancer worry, anxiety and depression. HRQoL in eSTS survivors treated with IR or ER is equal; for maintenance of physical functioning and functionality IR and ER outperform an amputation.