Limb Amputations in Cancer: Modern Perspectives, Outcomes, and Alternatives

Smith HG, Thomas JM, Smith MJF, Hayes AJ, Strauss DC. Major amputations for extremity soft-tissue sarcoma. Ann Surg Oncol. 2017;25:387–93. https://doi.org/10.1245/s10434-017-5895-2.

Article  PubMed  Google Scholar 

• Jauregui JJ, Nadarajah V, Munn J, Pivec R, Kapadia BH, Lerman DM, Maheshwari AV. Limb salvage versus amputation in conventional appendicular osteosarcoma: a systematic review. Ind J Surg Oncol. 2018:9:232–240. https://doi.org/10.1007/s13193-018-0725-y. This article highlights the differences in survivorship, metastasis rates, complication rates, and long-term satisfaction between amputation and limb salvage.

Hong S, Won Y-J, Park YR, Jung K-W, Kong H-J, Lee ES. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2017. Cancer Res Treat. 2020;52:335–50. https://doi.org/10.4143/crt.2020.206.

Article  PubMed  PubMed Central  Google Scholar 

Clark MA, Thomas JM. Amputation for soft-tissue sarcoma. Lancet Oncol. 2003;4:335–42. https://doi.org/10.1016/s1470-2045(03)01113-6.

Article  PubMed  Google Scholar 

Ghert MA, Abudu A, Driver N, et al. The indications for and the prognostic significance of amputation as the primary surgical procedure for localized soft tissue sarcoma of the extremity. Ann Surg Oncol. 2004;12:10–7. https://doi.org/10.1007/s10434-004-1171-3.

Article  PubMed  Google Scholar 

Kirilova M, Klein A, Lindner LH, Nachbichler S, Knösel T, Birkenmaier C, Baur-Melnyk A, Dürr HR. Amputation for extremity sarcoma: indications and outcomes. Cancers. 2021;13:5125. https://doi.org/10.3390/cancers13205125.

Article  PubMed  PubMed Central  Google Scholar 

Grimer RJ, Aydin BK, Wafa H, Carter SR, Jeys L, Abudu A, Parry M. Very long-term outcomes after endoprosthetic replacement for malignant tumours of bone. The Bone Joint J. 2016;98-B:857–64. https://doi.org/10.1302/0301-620X.98B6.37417.

Article  CAS  PubMed  Google Scholar 

Limakatso K, Bedwell GJ, Madden VJ, Parker R. The prevalence and risk factors for phantom limb pain in people with amputations: a systematic review and meta-analysis. PLoS ONE. 2020. https://doi.org/10.1371/journal.pone.0240431.

Article  PubMed  PubMed Central  Google Scholar 

Hanyu-Deutmeyer AA, Cascella M, Varacallo M. Phantom Limb Pain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448188/

Merimsky O, Kollender Y, Inbar M, Chaitchik S, Meller I. Palliative major amputation and quality of life in cancer patients. Acta Oncol. 1997;36(2):151–7. https://doi.org/10.3109/02841869709109223.

Article  CAS  PubMed  Google Scholar 

Bast RC. Holland-Frei Cancer Medicine. Hoboken: Wiley-Blackwell; 2023.

Google Scholar 

Elsner U, Henrichs M, Gosheger G, Dieckmann R, Nottrott M, Hardes J, Streitbürger A. Forequarter amputation: a safe rescue procedure in a curative and palliative setting in high-grade malignoma of the shoulder girdle. World J Surg Oncol. 2016;14(1):216. https://doi.org/10.1186/s12957-016-0973-7.

Article  PubMed  PubMed Central  Google Scholar 

Roșca AC, Baciu CC, Burtăverde V, Mateizer A. Psychological consequences in patients with amputation of a limb. An interpretative-phenomenological analysis. Front Psychol. 2021;12:537493. https://doi.org/10.3389/fpsyg.2021.537493.

Article  PubMed  PubMed Central  Google Scholar 

Geiger EJ, Liu W, Srivastava DK, Bernthal NM, Weil BR, Yasui Y, Ness KK, Krull KR, Goldsby RE, Oeffinger KC, Robison LL, Dieffenbach BV, Weldon CB, Gebhardt MC, Howell R, Murphy AJ, Leisenring WM, Armstrong GT, Chow EJ, Wustrack RL. What are risk factors for and outcomes of late amputation after treatment for lower extremity sarcoma: a childhood cancer survivor study report. Clin Orthop Relat Res. 2023;481(3):526–38. https://doi.org/10.1097/CORR.0000000000002243.

Article  PubMed  Google Scholar 

Fowler H, Belot A, Ellis L, Maringe C, Luque-Fernandez MA, Njagi EN, Navani N, Sarfati D, Rachet B. Comorbidity prevalence among cancer patients: a population-based cohort study of four cancers. BMC Cancer. 2020;20(1):2. https://doi.org/10.1186/s12885-019-6472-9.

Article  PubMed  PubMed Central  Google Scholar 

Anugraha A, Jehangir N, Alqubaisi M, Rafee A, Kurdy N, Pillai A. End-capping of amputation stumps with a local antibiotic containing hydroxyapatite bio-composite - a report of 13 cases with chronic lower limb osteomyelitis. J Orthop. 2019;17:124–6. https://doi.org/10.1016/j.jor.2019.11.007.

Article  PubMed  PubMed Central  Google Scholar 

Choo YJ, Kim DH, Chang MC. Amputation stump management: a narrative review. World J Clin Cases. 2022;10(13):3981–8. https://doi.org/10.12998/wjcc.v10.i13.3981.

Article  PubMed  PubMed Central  Google Scholar 

Jahmani R, Paley D. Stump overgrowth after limb amputation in children. Limb Amputation. 2020. https://doi.org/10.5772/intechopen.90532.

Article  Google Scholar 

Pasquali S, Gronchi A. Neoadjuvant chemotherapy in soft tissue sarcomas: latest evidence and clinical implications. Ther Adv Med Oncol. 2017;9(6):415–29. https://doi.org/10.1177/1758834017705588.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Welke B, Hurschler C, Schwarze M, Jakubowitz E, Aschoff HH, Örgel M. Comparison of conventional socket attachment and bone-anchored prosthesis for persons living with transfemoral amputation - mobility and quality of life. Clin Biomech. 2023;105: 105954. https://doi.org/10.1016/j.clinbiomech.2023.105954.

Article  Google Scholar 

• Black GG, Vaeth AM, Chen Y, Truong AY, Reif TJ, Rozbruch SR, Otterburn DM. Osseointegration for lower limb amputation: understanding the risk factors and time courses of soft tissue complications. Ann Plast Surg. 2023:90(6S Suppl 5):S452-S456. https://doi.org/10.1097/SAP.0000000000003477. This study highlights complications that can arise from osseointegration and factors that may be associated with post-operative complications.

Azar FM, Beaty JH, Daugherty K, Jones L, Campbell WC. Campbell’s operative orthopaedics. Philadelphia: Elsevier, Philadelphia; 2021.

Google Scholar 

Baumgartner RF. Knee disarticulation versus above-knee amputation. Prosthet Orthot Int. 1979;3(1):15–9. https://doi.org/10.3109/03093647909164695.

Article  CAS  PubMed  Google Scholar 

Kaneuchi Y, Yoshida S, Fujiwara T, Evans S, Abudu A. Limb salvage surgery has a higher complication rate than amputation but is still beneficial for patients younger than 10 years old with osteosarcoma of an extremity. J Pediatr Surg. 2022;57(11):702–9. https://doi.org/10.1016/j.jpedsurg.2022.04.001.

Article  PubMed  Google Scholar 

Lehnhardt M, Hirche C, Daigeler A, Goertz O, Ring A, Hirsch T, Drücke D, Hauser J, Steinau HU. Soft tissue sarcoma of the upper extremities. Analysis of factors relevant for prognosis in 160 patients. Chirurg. 2012;83(2):143–52. https://doi.org/10.1007/s00104-011-2124-6.

Article  CAS  PubMed  Google Scholar 

Farzaliyev F, Steinau HU, Ring A, Hamacher R, Thiel T, Lauer H, Podleska LE. Outcome of surgery as part of palliative care of patients with symptomatic advanced or metastatic extra-abdominal high-grade soft tissue sarcoma. Palliat Med Rep. 2023;3(1):64–70. https://doi.org/10.1089/pmr.2022.0063.

Article  PubMed  PubMed Central  Google Scholar 

Hoftiezer YAJ, Lans J, van der Heijden BEPA, Chen NC, Eberlin KR, Lozano-Calderón SA. Long-term patient-reported outcome measures following limb salvage with complex reconstruction or amputation in the treatment of upper extremity sarcoma. J Surg Oncol. 2021;123(5):1328–35. https://doi.org/10.1002/jso.26426.

Article  PubMed  Google Scholar 

Evans AG, Chaker SC, Curran GE, Downer MA, Assi PE, Joseph JT, Kassis SA, Thayer WP. Postamputation residual limb pain severity and prevalence: a systematic review and meta-analysis. Plast Surg (Oakv). 2022;30(3):254–68. https://doi.org/10.1177/22925503211019646.

Article  PubMed  Google Scholar 

Tukiainen E, Barner-Rasmussen I, Popov P, Kaarela O. Forequarter amputation and reconstructive options. Ann Plast Surg. 2020;84(6):651–6. https://doi.org/10.1097/SAP.0000000000002204.

Article  CAS  PubMed  Google Scholar 

•• Hoellwarth JS, Tetsworth K, Rozbruch SR, Handal MB, Coughlan A, Al Muderis M. Osseointegration for amputees: current implants, techniques, and future directions. JBJS Rev. 2020:8(3):e0043. https://doi.org/10.2106/JBJS.RVW.19.00043. This is a comprehensive review describing the different types of osseointegrated device designs that are currently in use.

Jaime KM, Reif TJ, Kafedzic H, Garrison G, Dhawan J, Rozbruch SR. Attachment of a myoelectric prosthesis after transulnar osseointegration implantation: a 2-patient case study. JBJS Case Connect. 2021:11(4). https://doi.org/10.2106/JBJS.CC.21.00381

Vandenberg NW, Stoneback JW, Davis-Wilson H, Christiansen CL, Awad ME, Melton DH, Gaffney BMM. Unilateral transfemoral osseointegrated prostheses improve joint loading during walking. J Biomech. 2023;155: 111658. https://doi.org/10.1016/j.jbiomech.2023.111658.

Article  PubMed  Google Scholar 

• Örgel M, Elareibi M, Graulich T, Krettek C, Neunaber C, Aschoff HH, Ranker A, Winkelmann M. Osseoperception in transcutaneous osseointegrated prosthetic systems (TOPS) after transfemoral amputation: a prospective study. Arch Orthop Trauma Surg. 2023:143(2):603–610. https://doi.org/10.1007/s00402-021-04099-1. This prospective study touches on the phenomenon of osseoperception and demonstrates that patients who undergo osseointegration may have improved sensory perception for tactile stimuli over traditional socket prostheses.

OpraTM implant system. In: Integrum. [Internet]. https://integrum.se/what-we-do/our-products-future-solutions/opra-implant-system/. Accessed 7 Nov 2023

Atallah R, Leijendekkers RA, Hoogeboom TJ, Frölke JP. Complications of bone-anchored prostheses for individuals with an extremity amputation: a systematic review. PLoS ONE. 2018;13(8): e0201821. https://doi.org/10.1371/journal.pone.0201821.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Hoellwarth JS, Tetsworth K, Kendrew J, Kang NV, van Waes O, Al-Maawi Q, Roberts C, Al Muderis M. Periprosthetic osseointegration fractures are infrequent and management is familiar. Bone Joint J. 2020;102-B(2):162–9. https://doi.org/10.1302/0301-620X.102B2.BJJ-2019-0697.R2.

Article  PubMed  PubMed Central  Google Scholar 

Örgel M, Petri M, Ranker A, Wirries N, Graulich T, Krettek C, Winkelmann M, Aschoff HH. Management, outcome, and novel classification system of periprosthetic fractures in patients with transcutaneous osseointegrated prosthetic systems (TOPS)-a retrospective cohort analysis. Arch Orthop Trauma Surg. 2022;142(7):1499–509. https://doi.org/10.1007/s00402-021-03826-y.

Article  PubMed  Google Scholar 

Kuiken TA, Li G, Lock BA, Lipschutz RD, Miller LA, Stubblefield KA, Englehart KB. Targeted muscle reinnervation for real-time myoelectric control of multifunction artificial arms. JAMA. 2009;301(6):619–28. https://doi.org/10.1001/jama.2009.116.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Cheesborough JE, Smith LH, Kuiken TA, Dumanian GA. Targeted muscle reinnervation and advanced prosthetic arms. Semin Plast Surg. 2015;29(1):62–72.

Comments (0)

No login
gif