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Limb-sparing surgery may not provide better
quality of life than amputation for bone
cancer patients
Limb-sparing surgery, which has been taking
the place of amputation for bone and soft
tissue sarcomas of the lower limb in recent
years, may not provide much or even any
additional benefit to patients according to
a new review.
The analysis, published in the September 15,
2009 issue of Cancer, a peer-reviewed
journal of the American Cancer Society,
indicates that patients and physicians
should rethink the pros and cons of
limb-sparing surgery and amputation.
Patients with tumors of the bone or soft
tissue in their arms and legs require
surgery to remove their cancer.
To compare the costs and benefits of
amputation compared with limb-sparing
surgery in these patients, Canadian
researchers Ronald Barr, M.D., M.B., Ch.B.,
of McMaster University and Jay Wunder, M.D.,
M.Sc., of the 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.
The review found that while limb-sparing
surgery is generally as effective as
amputation in ridding the patient of cancer,
it tends to be associated with more early
and late complications.
Surprisingly, 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. 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 looked at 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 longer term
costs related to artificial limb
manufacture, maintenance, and replacement.
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," said Dr. Wunder.
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