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Roubaud MS, Hassan AM, Shin A, Mericli AF, Adelman DM, Hagan K, Popat K, Lin P, Moon B, Lewis VO. Outcomes of Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces for Chronic Pain Control in the Oncologic Amputee Population. J Am Coll Surg 2023; 237:644-654. [PMID: 37278406 DOI: 10.1097/xcs.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Outcomes of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) in the oncologic population are limited. We sought to examine the safety and effectiveness of TMR and RPNI in controlling postamputation pain in the oncologic population. STUDY DESIGN A retrospective cohort study of consecutive patients who underwent oncologic amputation followed by immediate TMR or RPNI was conducted from November 2018 to May 2022. The primary study outcome was postamputation pain, assessed using the Numeric Pain Scale and Patient-Reported Outcomes Measurement Information System (PROMIS) for residual limb pain (RLP) and phantom limb pain (PLP). Secondary outcomes included postoperative complications, tumor recurrence, and opioid use. RESULTS Sixty-three patients were evaluated for a mean follow-up period of 11.3 months. The majority of patients (65.1%) had a history of previous limb salvage. At final follow-up, patients had an average Numeric Pain Scale score for RLP of 1.3 ± 2.2 and for PLP, 1.9 ± 2.6. The final average raw PROMIS measures were pain intensity 6.2 ± 2.9 (T-score 43.5), pain interference 14.6 ± 8.3 (T-score 55.0), and pain behavior 39.0 ± 22.1 (T-score 53.4). Patient opioid use decreased from 85.7% preoperatively to 37.7% postoperatively and morphine milligram equivalents decreased from a mean of 52.4 ± 53.0 preoperatively to 20.2 ± 38.4 postoperatively. CONCLUSIONS In the oncologic population TMR and RPNI are safe surgical techniques associated with significant reductions in RLP, PLP, and improvements in patient-reported outcomes. This study provides evidence for the routine incorporation of TMR and RPNI in the multidisciplinary care of oncologic amputees.
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Affiliation(s)
- Margaret S Roubaud
- From the Departments of Plastic and Reconstructive Surgery (Roubaud, Hassan, Mericli, Adelman), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Abbas M Hassan
- From the Departments of Plastic and Reconstructive Surgery (Roubaud, Hassan, Mericli, Adelman), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ashley Shin
- University of Texas, McGovern Medical School, Houston, TX (Shin)
| | - Alexander F Mericli
- From the Departments of Plastic and Reconstructive Surgery (Roubaud, Hassan, Mericli, Adelman), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David M Adelman
- From the Departments of Plastic and Reconstructive Surgery (Roubaud, Hassan, Mericli, Adelman), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Katherine Hagan
- Anesthesiology and Perioperative Medicine (Hagan, Popat), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Keyuri Popat
- Anesthesiology and Perioperative Medicine (Hagan, Popat), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Patrick Lin
- Orthopedic Surgery (Lin, Moon, Lewis), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bryan Moon
- Orthopedic Surgery (Lin, Moon, Lewis), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Valerae O Lewis
- Orthopedic Surgery (Lin, Moon, Lewis), The University of Texas MD Anderson Cancer Center, Houston, TX
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Rizkallah M, Ferguson PC, Basile G, Kim P, Werier J, Wilson D, Turcotte R. LUMiC® endoprosthesis for pelvic reconstruction: A Canadian experience. J Surg Oncol 2023; 127:727-733. [PMID: 36547873 DOI: 10.1002/jso.27181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/09/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The LUMiC® prosthesis was introduced to reduce the mechanical complications encountered with periacetabular reconstruction after pelvic tumor resection. Few have evaluated the outcomes associated with its use. METHODS A retrospective study from five Orthopedic Oncology Canadian centers was conducted. All patients with a LUMiC® endoprosthesis were included. Their charts were reviewed for surgical and functional outcomes. RESULTS A total of 16 patients were followed for 28 months (3-60). A total of 12 patients (75%) had a LUMiC® after a resection of a primary sarcoma. Mean surgical time was 555 min. Four patients (25%) had a two-stages procedure. MSTS score was 60.3 preoperatively and 54.3 postoperatively. Patients got a dual mobility bearing and the silver coated implant was used in 7 patients (43.7%). Five patients (31.3%) underwent capsular reconstruction using a fabric. Silver-coating was not found to reduce infection risk (p = 0.61) and capsuloplasty did not prevent dislocation (p = 0.6). Five patients had peroperative complications (31.3%). Eight patients (50%) had an infection including all four with two-stages surgery. Dislocation occurred in five patients (31.3%) whereas no cases of aseptic loosening were reported. A total of 10 patients (62.5%) needed a reoperation. CONCLUSION LUMiC® endoprosthesis provides low rates of aseptic loosening on medium-term follow-up. Infection and dislocation are common complications but we were unable to show benefits of capsuloplasty and silver-coated implants.
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Affiliation(s)
- Maroun Rizkallah
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter C Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Canada, Ontario
| | - Georges Basile
- Department of Surgery, Hôpital Maisonneuve-Rosemont, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Paul Kim
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, General Campus, University of Ottawa, Ottawa, Ontario, Canada
| | - Joel Werier
- Division of Orthopaedic Surgery, Departmentof Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - David Wilson
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert Turcotte
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Hagi T, Nakamura T, Nagano A, Koike H, Yamada K, Aiba H, Fujihara N, Wasa J, Asanuma K, Kozawa E, Ishimura D, Kawanami K, Izubuchi Y, Shido Y, Sudo A, Nishida Y. Clinical outcome in patients who underwent amputation due to extremity soft tissue sarcoma: Tokai Musculoskeletal Oncology Consortium study. Jpn J Clin Oncol 2021; 52:157-162. [PMID: 34875695 DOI: 10.1093/jjco/hyab184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Soft tissue sarcomas are a diverse group of rare malignant tumours, mostly occurring in the lower extremities. Amputations are necessary for achieving local control when the soft tissue sarcomas are too large and/or have neurovascular involvement. Patients who require amputation have a poorer prognosis than those who undergo limb-salvage surgery. PATIENTS AND METHODS We investigated the tumour characteristics and the clinical outcomes in 55 patients with primary soft tissue sarcomas, who underwent amputation. We excluded patients with amputation performed distal to the wrist or ankle joints and those with recurrent soft tissue sarcomas. RESULTS The mean tumour size was 11.1 cm. Hip disarticulation was performed in 6 patients, 20 underwent above the knee amputation, 8 underwent knee disarticulation and 12 underwent below the knee amputation. Shoulder disarticulation was performed in three patients, five underwent above the elbow amputation, and one underwent below the elbow amputation. The 5-year disease-specific survival rate was 52.8%. The 5-year recurrence-free survival rate and 5-year metastasis-free survival rates were 90.1% and 38.5%, respectively. Larger tumour size, age and the distant metastases at first presentation were predictors of poor prognosis for survival in multivariate analysis. Twenty-eight patients could walk using artificial limbs. The level of amputation (above versus below the knee) showed a significant difference in achieving independent gait. CONCLUSION Amputation is a useful treatment option for achieving local control in patients with large soft tissue sarcomas. Patients had an opportunity of walking, especially for those who underwent below the knee amputation.
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Affiliation(s)
- Tomohito Hagi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University, Gifu, Japan
| | - Hiroshi Koike
- Department of Orthopaedic Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Kenji Yamada
- Department of Orthopaedic Oncology, Okazaki City Hospital, Okazaki, Japan
| | - Hisaki Aiba
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nasa Fujihara
- Division of Orthopaedic Surgery, Aichi Cancer Centre Hospital, Nagoya, Japan
| | - Junji Wasa
- Division of Orthopaedic Oncology, Shizuoka Cancer Centre Hospital, Shizuoka, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eiji Kozawa
- Department of Orthopaedic Surgery, Nagoya Memorial Hospital, Nagoya, Japan
| | - Daisuke Ishimura
- Department of Orthopaedic Surgery, Fujita Medical University, Nagoya, Japan
| | - Katsuhisa Kawanami
- Department of Orthopaedic Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yuya Izubuchi
- Department of Orthopaedic Surgery, Fukui University Graduate School of Medicine, Fukui, Japan
| | - Yoji Shido
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Hospital, Nagoya, Japan.,Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
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Amputation for Extremity Sarcoma: Indications and Outcomes. Cancers (Basel) 2021; 13:cancers13205125. [PMID: 34680274 PMCID: PMC8533806 DOI: 10.3390/cancers13205125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary Sarcomas are malignant tumors of soft tissues or bone. While limb salvage surgery (LSS) is the standard treatment, amputation is an option especially in local recurrence (LR) or complications after LSS. Two groups with primary amputations (n = 120) or secondary amputations after failed LSS due to LR or complications (n = 29) were compared. Five-year LR-free survival was 84% and 17 (16%) patients developed LR, of which 16 were in group I and only one in group II. Overall survival (OS) at five years was 44%, and the rate was identical in both groups. In those group II patients who had a secondary amputation after LSS due to contaminated margins or LR (n = 12) five-year OS was 33% compared to 48% in patients with complications (n = 17). This study indicates the worse oncological outcomes with respect to OS of sarcoma patients needing an amputation as compared to LSS. Patients with primary amputation or those who had a secondary amputation after failed LSS for whatever reason showed the same results. Abstract Background: Sarcomas are rare, malignant tumors of soft tissues or bone. Limb salvage surgery (LSS) is the standard treatment, but amputation is still an option, especially in local recurrence or complications after LSS. Methods: We retrospectively reviewed indications and oncological outcomes in patients who underwent an amputation. Two groups with either primary amputations (n = 120) or with secondary amputations after failed LSS with local recurrence or complications (n = 29) were compared with the main end points of LRFS and OS. Results: Five-year LRFS was 84% with 17 (16%) patients developing local recurrence, of which 16 (13%) occurred in group I. Forty-two (28%) patients developed metastatic disease and overall survival at five years was 44%. Overall survival (OS) was the same in both groups. In those group II patients who had a secondary amputation due to LR or insufficient margins after LSS (n = 12) the five-year OS was 33% compared to 48% in patients with amputation due to complications (n = 17) (n.s.). Conclusions: This study indicates the worse oncological outcomes with respect to OS of sarcoma patients requiring an amputation as compared to LSS. Patients with primary amputation or those who had a secondary amputation after failed LSS for whatever reason showed the same oncological results.
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Yulian ED, Pandelaki J, Kodrat E, Wibisana IGNG. Forequarter amputation post transarterial chemoembolization and radiation in synovial sarcoma: A case report. Int J Surg Case Rep 2021; 81:105824. [PMID: 33887868 PMCID: PMC8027265 DOI: 10.1016/j.ijscr.2021.105824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Forequarter amputation or interscapulathoracalis amputation is a major amputation procedure that involves the entire upper extremity, scapula, and a whole or part of the clavicula. Forequarter amputation is commonly used to control bleeding in malignant tumor cases in which no treatment is available for the extremities. CASE PRESENTATION We report a case of forequarter amputation in a 25-year-old patient with synovial sarcoma. Transarterial chemoembolization (TACE) and radiation synovial sarcoma were performed in the patient to reduce bleeding. This technique may also be used for treating synovial sarcoma with massive bleeding. CLINICAL DISCUSSION Despite forequarter amputation indications in malignant tumor cases and recurrent cancer cases, the effectiveness of this technique remains unclear. The patient was readmitted with a recurrent mass three months after surgery. CONCLUSION In this study, TACE and radiotherapy are effective in controlling bleeding preoperatively and intraoperatively in patients with synovial sarcoma.
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Affiliation(s)
- Erwin Danil Yulian
- Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.
| | - Jacub Pandelaki
- Interventional Radiology Division, Department of Radiology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
| | - Evelina Kodrat
- Department of Anatomical Pathology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
| | - I Gusti Ngurah Gunawan Wibisana
- Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
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Erol B, Sofulu O, Sirin E, Saglam F, Buyuktopcu O. Reconstruction after periacetabular tumor resection with Lumic® endoprosthesis: What are the midterm results? J Surg Oncol 2020; 123:532-543. [PMID: 33238055 DOI: 10.1002/jso.26318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/24/2020] [Accepted: 11/14/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This study aimed to analyze the midterm outcomes of LUMiC® endoprosthetic reconstruction following periacetabular resection of primary bone sarcomas and carcinoma metastases. PATIENTS AND METHODS We retrospectively reviewed the charts of 21 patients (11 male [52.3%], 10 female [47.6%]; mean age 47 ± 16 years) for whom a LUMiC® endoprosthesis (Implantcast) was used to reconstruct a periacetabular defect after internal hemipelvectomy. The tumor was pathologically diagnosed as Ewing's sarcoma in six (28.5%), chondrosarcoma in 10 (47.6%), and bone metastasis from carcinoma in five (23.8%) patients. RESULTS The median follow-up of patients was 57.8 months (95% confidence interval: 51.9-63.7). The implant survival rate at 1, 2, and 5 years were 95.2%, 85.7%, and 80.9%, respectively. The overall complication rate was 33.3% (n = 7). Four (19%) complications resulted in reconstruction failure. Total reoperation rate was 28.5% (n = 6). The complications were soft tissue failure/dislocation in two patients, aseptic loosening in one, infection in two, and local recurrence in two. At the time of study, seven patients were alive with no evidence of disease, seven were alive with disease, and seven died of disease. The 5-year overall survival rate and local recurrence-free survival rates were 67% and 76%, respectively. The median Musculoskeletal Tumor Society score at final follow-up was 70% (range: 50%-86.6%). CONCLUSION We conclude that LUMiC® endoprosthesis provides good functional outcomes and a durable reconstruct. Even though this reconstruction method presents some complications, it provides a stable pelvis in the management of periacetabular malignant tumors.
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Affiliation(s)
- Bulent Erol
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Omer Sofulu
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Evrim Sirin
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fevzi Saglam
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Omer Buyuktopcu
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
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Kiiski J, Parry MC, Le Nail LR, Sumathi V, Stevenson JD, Kaartinen IS, Jeys LM, Laitinen MK. Surgical and oncological outcomes after hindquarter amputation for pelvic sarcoma. Bone Joint J 2020; 102-B:788-794. [DOI: 10.1302/0301-620x.102b6.bjj-2019-1317.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Survival rates and local control after resection of a sarcoma of the pelvis compare poorly to those of the limbs and have a high incidence of complications. The outcome for patients who need a hindquarter amputation (HQA) to treat a pelvic sarcoma is poor. Our aim was to evaluate the patient, tumour, and reconstructive factors that affect the survival of the patients who undergo HQA for primary or recurrent pelvic sarcoma. Methods We carried out a retrospective review of all sarcoma patients who had undergone a HQA in a supraregional sarcoma unit between 1996 and 2018. Outcomes included oncological, surgical, and survival characteristics. Results A total of 136 patients, with a mean age of 51 (12 to 83) underwent HQA, 91 for a bone sarcoma and 45 for a soft tissue sarcoma. The overall survival (OS) after primary HQA for a bone sarcoma was 90.7 months (95% confidence interval (CI) 64.1 to 117.2). In patients undergoing a secondary salvage HQA it was 90.3 months (95% CI 58.1 to 122.5) (p = 0.727). For those treated for a soft tissue sarcoma (STS), the mean OS was 59.3 months (95% CI 31.1 to 88.6) for patients with a primary HQA, and 12.5 months (95% CI 9.4 to 15.5) for those undergoing a secondary salvage HQA (p = 0.038). On multivariate analysis, high histological grade (hazard ratio (HR) 2.033, 95% CI 1.127 to 3.676; p = 0.018) and a diagnosis of STS (HR 1.653, 95% CI 1.027 to 2.660; p = 0.039) were associated with a poor prognosis. The 30-day mortality for patients with curative intent was 0.8% (1/128). For those in whom surgery was carried out with palliative intent it was 33.3% (2/6) (p = 0.001). In total, 53.7% (n = 73) of patients had at least one complication with 23.5% (n = 32) requiring at least one further operation. Direct closure was inferior to flap reconstruction in terms of complete primary wound healing (60.0% (3/5) vs 82.0% (82/100); p = 0.023). Conclusion In carefully selected patients HQA is associated with satisfactory overall survival, with a low risk of perioperative mortality, but considerable morbidity. However, caution must be exercised when considering the procedure for palliation due to the high incidence of early postoperative mortality. Cite this article: Bone Joint J 2020;102-B(6):788–794.
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Affiliation(s)
- Juha Kiiski
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Michael C. Parry
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Luis-Romee Le Nail
- Orthopaedic Surgery Department, University Hospital of Tours, Medical University of Tours, Tours, France
| | - Vaiyapuri Sumathi
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan D. Stevenson
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Ilkka S. Kaartinen
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Lee M. Jeys
- Royal Orthopaedic Hospital, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Minna K. Laitinen
- Helsinki University Hospital, Department of Orthopaedics, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
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Abstract
OBJECTIVE This study aimed to present the results of a series of forequarter amputations (FQAs) and to evaluate the reconstructive methods used. SUMMARY BACKGROUND DATA Although FQA has become a rare procedure in the era of limb-sparing treatment of extremity malignancies, it is a useful option when resection of a shoulder girdle or proximal upper extremity tumor cannot be performed so as to retain a functional limb. METHODS Thirty-four patients were treated with FQA in 1989 to 2017. Various reconstructive techniques were used, including free fillet flaps from the amputated extremity. RESULTS All patients presented with intractable symptoms such as severe pain, motor or sensory deficit, or limb edema. Seventeen patients were treated with palliative intent. Chest wall resection was performed in 9 patients. Free flap reconstruction was necessary for 15 patients, with 11 free flaps harvested from the amputated extremity. There was no operative mortality, and no free flaps were lost. In curatively treated patients, estimated 5-year disease-specific survival was 60%. Median survival in the palliatively treated group was 13 months (1-35 months). CONCLUSIONS Limb-sparing treatment is preferable for most shoulder girdle and proximal upper extremity tumors. Sometimes, FQA is the only option enabling curative treatment. In palliative indications, considerable disease-free intervals and relief from disabling symptoms can be achieved. The extensive tissue defects caused by extended FQA can be safely and reliably reconstructed by means of free flaps, preferably harvested from the amputated extremity.
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Sawyer J, Van Boerum MS, Groundland J, Lorimer S, Agarwal J. Free tibia and fibula-fillet-of-leg flap for pelvic ring reconstruction: A case report. Microsurgery 2020; 40:492-496. [PMID: 32022325 DOI: 10.1002/micr.30559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/28/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022]
Abstract
Pelvic sarcoma resections present large and complex defects, which are a challenge to reconstruct. At times, these cancers are treated with external hemipelvectomy, and both the soft tissue and bony framework of the pelvic ring must be addressed. The purpose of this case report is to describe the use of a free tibia and fibula-fillet-of-leg flap for pelvic ring reconstruction, performed to enhance the quality of life of a patient following hemipelvectomy. A 50-year-old female with advanced stage undifferentiated pleomorphic sarcoma of the left thigh and pelvis underwent free vascularized tibia and fibula-fillet-of-leg flap, including 21 cm of bone length and 21 cm long and full circumferential soft tissues of the leg, accompanying the bone, for the reconstruction of the bony pelvis and soft tissue. Postoperatively, the patient had no surgical complications, was followed for 6 months and went on to have bony healing, and was able to sit prior to disease progression and eventual death from metastatic disease. In the reported case, we have shown that composite tibia-fibula free flap with lower leg soft tissues may be a viable option for the reconstruction of massive external hemipelvectomy defects.
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Affiliation(s)
- Justin Sawyer
- The Institute for Plastic Surgery, Southern Illinois, University School of Medicine, Springfield, Illinois
| | | | - John Groundland
- Department of Orthopedics, Sarcoma Services, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Shannon Lorimer
- Department of Orthopedics, Sarcoma Services, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jayant Agarwal
- Division of Plastic and Reconstructive Surgery, University of Utah Health Care, Salt Lake City, Utah
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Alexander JH, Jordan SW, West JM, Compston A, Fugitt J, Bowen JB, Dumanian GA, Pollock R, Mayerson JL, Scharschmidt TJ, Valerio IL. Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol. J Surg Oncol 2019; 120:348-358. [PMID: 31197851 DOI: 10.1002/jso.25586] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/14/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. METHODS Our TMR cohort was compared to a cross-sectional sample of unselected oncologic amputees not treated at our institution (N = 58). Patient-Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain. RESULTS Thirty-one patients underwent amputation with concurrent TMR during the study; 27 patients completed pain surveys; 15 had greater than 1 year follow-up (mean follow-up 14.7 months). Neuroma symptoms occurred significantly less frequently and with less intensity among the TMR cohort. Mean differences for PROMIS pain intensity, behavior, and interference for phantom limb pain (PLP) were 5.855 (95%CI 1.159-10.55; P = .015), 5.896 (95%CI 0.492-11.30; P = .033), and 7.435 (95%CI 1.797-13.07; P = .011) respectively, with lower scores for TMR cohort. For residual limb pain, PROMIS pain intensity, behavior, and interference mean differences were 5.477 (95%CI 0.528-10.42; P = .031), 6.195 (95%CI 0.705-11.69; P = .028), and 6.816 (95%CI 1.438-12.2; P = .014), respectively. Fifty-six percent took opioids before amputation compared to 22% at 1 year postoperatively. CONCLUSIONS Multidisciplinary care of amputees including concurrent amputation and TMR, multimodal postoperative pain management, amputee-centered rehabilitation, and peer support demonstrates reduced incidence and severity of neuroma and PLP.
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Affiliation(s)
- John H Alexander
- Department of Orthopaedics, The Ohio State University James Wexner Medical Center, Columbus, Ohio
| | - Sumanas W Jordan
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Julie M West
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Amy Compston
- Department of Oncologic Rehabilitation, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio
| | - Jennifer Fugitt
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - J Byers Bowen
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Gregory A Dumanian
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Raphael Pollock
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Joel L Mayerson
- Department of Orthopaedics, The Ohio State University James Wexner Medical Center, Columbus, Ohio
| | - Thomas J Scharschmidt
- Department of Orthopaedics, The Ohio State University James Wexner Medical Center, Columbus, Ohio
| | - Ian L Valerio
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Gil S, Fernandez-Pineda I, Rao B, Neel MD, Baker JN, Wu H, Wu J, Anghelescu DL. Role of Amputation in Improving Mobility, Pain Outcomes, and Emotional and Psychological Well-Being in Children With Metastatic Osteosarcoma. Am J Hosp Palliat Care 2018; 36:105-110. [PMID: 30058346 DOI: 10.1177/1049909118791119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND: Few studies have analyzed the benefit of limb amputations in children with metastatic osteosarcoma and limited life span. OBJECTIVE: We studied outcomes of limb amputations in children with metastatic osteosarcoma. DESIGN: We performed a retrospective review of patients who underwent limb amputations (January 1995-June 2015) and died within 1 year of surgery. SETTING/PARTICIPANTS: We studied 12 patients with osteosarcoma at a single institution. MEASUREMENTS: Data on mobility, pain, and emotional and psychological well-being were retrieved from medical records from 1 month before surgery to 6 months after surgery. RESULTS: Of the 12 patients (7 females and 5 males; median age at surgery 13 years [range, 7-20 years]) meeting study criteria, 3 patients and 9 patients had primary osteosarcoma in upper and lower limbs, respectively. Mobility improved postamputation in 8 bedridden/wheelchair-bound patients. Postamputation, emotional, and psychological well-being improved for 9 patients, 3 patients had persistent psychological and/or emotional symptoms, and no patient experienced signs of regret. Daily mean pain scores were significantly lower at 1 week (median 3 [range, 0-6]; P = .03) and 3 months (median 0 [range, 0-8]; P = .02) postsurgery than at 1 week presurgery (median 5.5 [range, 0-10]). Morphine consumption (mg/kg/d) showed a trend toward higher values at 1 week (median 0.2 [range, 0-7.6]; P = .6) and 3 months (median 0.2 [range, 0-0.5]; P = .3) postsurgery than at 1 week presurgery (median 0.1 [range, 0-0.5]). CONCLUSIONS: Patients undergoing limb amputations had reduced pain and improved mobility and emotional and psychological well-being. Amputations are likely to benefit children with limited life expectancy.
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Affiliation(s)
- Sebastian Gil
- 1 Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Bhaskar Rao
- 1 Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael D Neel
- 1 Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Justin N Baker
- 2 Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Huiyun Wu
- 3 Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jianrong Wu
- 3 Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Doralina L Anghelescu
- 4 Division of Anesthesiology, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
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Li D, Xie L, Guo W, Tang X, Ji T, Yang R. Extra-articular resection is a limb-salvage option for sarcoma involving the hip joint. INTERNATIONAL ORTHOPAEDICS 2018; 42:695-703. [PMID: 29404667 DOI: 10.1007/s00264-018-3771-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/05/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION With the development of surgical techniques and improvements in hemi-pelvic prosthesis systems, extra-articular resection can be performed as a limb-salvage procedure in selected patients whose hip joint is invaded by a sarcoma. The aim of this study was to describe the indications for and the technical details, post-operative complications, and oncologic and functional outcomes of this procedure. METHODS Eighteen patients with Enneking IIB or IB sarcoma who underwent extra-articular resection of the hip joint were enrolled. A modular pelvic endoprosthesis combined with a femoral endoprosthesis was used to reconstruct the bone and joint defect. Pathological diagnoses included osteosarcoma (7 patients), chondrosarcoma (7), undifferentiated high-grade pleomorphic sarcoma (3), and malignant peripheral nerve-sheath tumour (1). RESULTS Wide, marginal and intralesional surgical margin was achieved in 13, four and one patients, respectively. There was one peri-operative death and the other 17 patients were followed up for 35.0 months (range, 10-75 months). Three patients had early-stage dislocations. One had a traumatic dislocation three years later. Two patients had wound complications. The average MSTS 93 score was 63.5% ± 10.8%. Four patients had local recurrence. The estimated three-year disease-free survival and overall survival for the 18 patients were both 50.0%. CONCLUSION Although technically demanding, extra-articular resection of hip is a limb-salvage procedure that is worth considering for carefully selected patients.
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Affiliation(s)
- Dasen Li
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China
| | - Lu Xie
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China.
| | - Xiaodong Tang
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China
| | - Tao Ji
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China
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Stevenson MG, Musters AH, Geertzen JH, van Leeuwen BL, Hoekstra HJ, Been LB. Amputations for extremity soft tissue sarcoma in an era of limb salvage treatment: Local control and survival. J Surg Oncol 2017; 117:434-442. [DOI: 10.1002/jso.24881] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/18/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Marc G. Stevenson
- Department of Surgical Oncology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Annelie H. Musters
- Department of Surgical Oncology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Jan H.B. Geertzen
- Department of Rehabilitation Medicine; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Barbara L. van Leeuwen
- Department of Surgical Oncology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Harald J. Hoekstra
- Department of Surgical Oncology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
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Moura DL, Garruço A. Hip disarticulation - case series analysis and literature review. Rev Bras Ortop 2017; 52:154-158. [PMID: 28409131 PMCID: PMC5380801 DOI: 10.1016/j.rboe.2016.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 09/01/2016] [Indexed: 11/29/2022] Open
Abstract
Objective To present a retrospective study of 16 patients submitted to hip disarticulation. Methods During the period of 16 years, 16 patients who underwent hip disarticulation were identified. All of them were studied based on clinical records regarding the gender, age at surgery, disarticulation cause, postoperative complications, mortality rates and functional status after hip disarticulation. Results Hip disarticulation was performed electively in most cases and urgently in only three cases. The indications had the following origins: infection (n = 6), tumor (n = 6), trauma (n = 3), and ischemia (n = 2). The mean post-surgery survival was 200.5 days. The survival rates were 6875% after six months, 5625% after one year, and 50% after three years. The mortality rates were higher in disarticulations with traumatic (66.7%) and tumoral (60%) causes. Regarding the eight patients who survived, half of them ambulate with crutches and without prosthesis, 25% walk with limb prosthesis, and 25% are bedridden. Complications and mortality were higher in the cases of urgent surgery, and in those with traumatic and tumoral causes. Conclusion Hip disarticulation is a major ablative surgery with obvious implications for limb functionality, as well as high rates of complications and mortality. However, when performed at the correct time and with proper indication, this procedure can be life-saving and can ensure the return to the home environment with a certain degree of quality of life.
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Affiliation(s)
- Diogo Lino Moura
- Centro Hospitalar e Universitário de Coimbra, Departamento de Ortopedia, Coimbra, Portugal
| | - António Garruço
- Centro Hospitalar e Universitário de Coimbra, Departamento de Ortopedia, Coimbra, Portugal
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15
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Moura DL, Garruço A. Desarticulação da anca – Análise de uma série e revisão da literatura. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Survival rate and perioperative data of patients who have undergone hemipelvectomy: a retrospective case series. World J Surg Oncol 2016; 14:255. [PMID: 27716330 PMCID: PMC5054560 DOI: 10.1186/s12957-016-1001-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/08/2016] [Indexed: 12/11/2022] Open
Abstract
Background Hemipelvectomy is a major orthopedic surgical procedure indicated in specific situations. Although many studies discuss surgical techniques for hemipelvectomy, few studies have presented survival data, especially in underdeveloped countries. Additionally, there is limited information on anesthesia for orthopedic oncologic surgeries. The primary aim of this study was to determine the survival rate after hemipelvectomy, and the secondary aims were to evaluate anesthesia and perioperative care associated with hemipelvectomy and determine the influence of the surgical technique (external hemipelvectomy [amputation] or internal hemipelvectomy [limb sparing surgery]) on anesthesia and perioperative care in Brazil. Methods This retrospective case series collected data from 35 adult patients who underwent hemipelvectomy between 2000 and 2013. Survival rates after surgery were determined, and group comparisons were performed using the Kaplan–Meier method and the log-rank test. Mantel–Cox test and multiple linear regression analysis with stepwise forward selection were performed for univariate and multivariate analyses, respectively. Results Mean survival time was 32.8 ± 4.6 months and 5-year survival rate was 27 %. Of the 35 patients, 23 patients (65.7 %) underwent external hemipelvectomy and 12 patients (34.3 %) underwent internal hemipelvectomy. The survival rate was significantly higher in patients with bone tumors than in those with soft tissue sarcomas (P = 0.024). The 5-year cumulative probability of survival was significantly lower in patients who underwent external hemipelvectomy than in those who underwent internal hemipelvectomy (P = 0.043). In the univariate and multivariate analyses, only advanced disease stage (3 and 4) was identified as a significant independent predictor of reduced survival (P = 0.0003). Balanced general anesthesia combined with epidural block was the most frequent anesthesia technique. Median intraoperative crystalloid volume and red blood cell transfusions were 3500 mL and 2 units, respectively. Conclusions Overall mean survival time after hemipelvectomy was 32.8 months. Advanced disease stage might be independently associated with reduced survival. Smaller amounts of fluids and transfusions were administered and time to discharge was shorter. Acute and chronic pain as well as wound complications are still important challenges in hemipelvectomy.
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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; 14:216. [PMID: 27526689 PMCID: PMC4986170 DOI: 10.1186/s12957-016-0973-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/04/2016] [Indexed: 12/15/2022] Open
Abstract
Background Forequarter amputation (FQA) is a surgical treatment of tumors in the upper extremity and shoulder girdle that infiltrate the neurovascular bundles. In both curative and palliative settings, FQA can serve as an effective oncological treatment. Methods This study presents the FQA-related data of 30 patients (mean age 50 years) treated between 2000 and 2012. Their medical condition was high-grade bone or soft tissue sarcoma in 26 and high-grade carcinoma in four cases. Results Mean operation time was 119 min. One major and five minor complications occurred in the postoperative period. Resection margins were wide in 91 % of patients. Local recurrence was observed in four patients after 19 months on average. Patients treated with curative intention had a 5-year survival chance of 39 %. Average survival after palliative amputation was 11 months. Conclusions FQA provides an opportunity for adequate oncological margins in large tumors, while offering relief from tumor-induced distress in palliative situations.
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Affiliation(s)
- Ulrich Elsner
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Marcel Henrichs
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Ralf Dieckmann
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Markus Nottrott
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Jendrik Hardes
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Arne Streitbürger
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Furtado S, Grimer RJ, Cool P, Murray SA, Briggs T, Fulton J, Grant K, Gerrand CH. Physical functioning, pain and quality of life after amputation for musculoskeletal tumours. Bone Joint J 2015; 97-B:1284-90. [DOI: 10.1302/0301-620x.97b9.35192] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patients who have limb amputation for musculoskeletal tumours are a rare group of cancer survivors. This was a prospective cross-sectional survey of patients from five specialist centres for sarcoma surgery in England. Physical function, pain and quality of life (QOL) outcomes were collected after lower extremity amputation for bone or soft-tissue tumours to evaluate the survivorship experience and inform service provision. Of 250 patients, 105 (42%) responded between September 2012 and June 2013. From these, completed questionnaires were received from 100 patients with a mean age of 53.6 years (19 to 91). In total 60 (62%) were male and 37 (38%) were female (three not specified). The diagnosis was primary bone sarcoma in 63 and soft-tissue tumour in 37. A total of 20 tumours were located in the hip or pelvis, 31 above the knee, 32 between the knee and ankle and 17 in the ankle or foot. In total 22 had hemipelvectomy, nine hip disarticulation, 35 transfemoral amputation, one knee disarticulation, 30 transtibial amputation, two toe amputations and one rotationplasty. The Toronto Extremity Salvage Score (TESS) differed by amputation level, with poorer scores at higher levels (p < 0.001). Many reported significant pain. In addition, TESS was negatively associated with increasing age, and pain interference scores. QOL for Cancer Survivors was significantly correlated with TESS (p < 0.001). This relationship appeared driven by pain interference scores. This unprecedented national survey confirms amputation level is linked to physical function, but not QOL or pain measures. Pain and physical function significantly impact on QOL. These results are helpful in managing the expectations of patients about treatment and addressing their complex needs. Cite this article: Bone Joint J 2015;97-B:1284–90.
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Affiliation(s)
- S. Furtado
- Freeman Hospital, Newcastle
Upon Tyne, United Kingdom, NE7
7DN, UK
| | - R. J. Grimer
- Royal Orthopaedic Hospital NHS Foundation
Trust, Birmingham, B31
2AP, UK
| | - P. Cool
- Robert Jones and Agnes Hunt NHS Foundation
Trust, Oswestry, SY10
7AG, UK
| | - S. A. Murray
- Freeman Hospital, Newcastle
Upon Tyne, United Kingdom, NE7
7DN, UK
| | - T. Briggs
- Royal National Orthopaedic Hospital NHS
Trust, Stanmore, London, HA7
4LP, UK
| | - J. Fulton
- Royal National Orthopaedic Hospital NHS
Trust, Stanmore, London, HA7
4LP, UK
| | - K. Grant
- Robert Jones and Agnes Hunt NHS Foundation
Trust, Oswestry, SY10
7AG, UK
| | - C. H. Gerrand
- The Freeman Hospital, High
Heaton, Newcastle upon Tyne, NE7
7DN, UK
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Daigeler A, Harati K, Kapalschinski N, Goertz O, Hirsch T, Lehnhardt M, Kolbenschlag J. Plastic surgery for the oncological patient. Front Surg 2015; 1:42. [PMID: 25593966 PMCID: PMC4287133 DOI: 10.3389/fsurg.2014.00042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/01/2014] [Indexed: 12/11/2022] Open
Abstract
The therapy of oncological patients has seen tremendous progress in the last decades. For most entities, it has been possible to improve the survival as well as the quality of life of the affected patients. To supply optimal cancer care, a multidisciplinary approach is vital. Together with oncologists, radiotherapists and other physicians, plastic surgeons can contribute to providing such care in all stages of treatment. From biopsies to the resection of advanced tumors, the coverage of the resulting defects and even palliative care, plastic surgery techniques can help to improve survival and quality of life as well as mitigate negative effects of radiation or the problems arising from exulcerating tumors in a palliative setting. This article aims to present the mentioned possibilities by illustrating selected cases and reviewing the literature. Especially in oncological patients, restoring their quality of life with the highest patient safety possible is of utmost importance.
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Affiliation(s)
- Adrien Daigeler
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum , Bochum , Germany
| | - Kamran Harati
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum , Bochum , Germany
| | - Nicolai Kapalschinski
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum , Bochum , Germany
| | - Ole Goertz
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum , Bochum , Germany
| | - Tobias Hirsch
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum , Bochum , Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum , Bochum , Germany
| | - Jonas Kolbenschlag
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum , Bochum , Germany
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Abstract
The threat of lower limb loss is seen commonly in severe crush injury, cancer ablation, diabetes, peripheral vascular disease and neuropathy. The primary goal of limb salvage is to restore and maintain stability and ambulation. Reconstructive strategies differ in each condition such as: Meticulous debridement and early coverage in trauma, replacing lost functional units in cancer ablation, improving vascularity in ischaemic leg and providing stable walking surface for trophic ulcer. The decision to salvage the critically injured limb is multifactorial and should be individualised along with laid down definitive indications. Early cover remains the standard of care, delayed wound coverage not necessarily affect the final outcome. Limb salvage is more cost-effective than amputations in a long run. Limb salvage is the choice of procedure over amputation in 95% of limb sarcoma without affecting the survival. Compound flaps with different tissue components, skeletal reconstruction; tendon transfer/reconstruction helps to restore function. Adjuvant radiation alters tissue characters and calls for modification in reconstructive plan. Neuropathic ulcers are wide and deep often complicated by osteomyelitis. Free flap reconstruction aids in faster healing and provides superior surface for offloading. Diabetic wounds are primarily due to neuropathy and leads to six-fold increase in ulcerations. Control of infections, aggressive debridement and vascular cover are the mainstay of management. Endovascular procedures are gaining importance and have reduced extent of surgery and increased amputation free survival period. Though the standard approach remains utilising best option in the reconstruction ladder, the recent trend shows running down the ladder of reconstruction with newer reliable local flaps and negative wound pressure therapy.
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Affiliation(s)
- Dinesh Kadam
- Department of Plastic and Reconstructive Surgery, A J Institute of Medical Sciences and A J Hospital and Research Centre, Kuntikana, Mangalore, Karnataka, India
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Wilks DJ, Hassan Z, Bhasker D, Kay SPJ. Re: Shoulder silhouette and axilla reconstruction with free composite elbow tissue transfer following interscapulothoracic amputation. J Plast Reconstr Aesthet Surg 2014; 67:1162-4. [PMID: 24725725 DOI: 10.1016/j.bjps.2014.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/15/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Daniel J Wilks
- The Department of Plastic, Reconstructive and Hand Surgery, Leeds General Infirmary, Leeds, UK.
| | - Zahid Hassan
- The Department of Plastic, Reconstructive and Hand Surgery, Leeds General Infirmary, Leeds, UK
| | - Diana Bhasker
- The Department of Plastic, Reconstructive and Hand Surgery, Leeds General Infirmary, Leeds, UK
| | - Simon P J Kay
- The Department of Plastic, Reconstructive and Hand Surgery, Leeds General Infirmary, Leeds, UK
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Kwong TNK, Furtado S, Gerrand C. What do we know about survivorship after treatment for extremity sarcoma? A systematic review. Eur J Surg Oncol 2014; 40:1109-24. [PMID: 24767804 DOI: 10.1016/j.ejso.2014.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/20/2014] [Accepted: 03/19/2014] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The varied presentations and treatments of extremity bone and soft tissue sarcoma mean that the issues faced by survivors are diverse and complex. The aim of this systematic review was to investigate what is known about this topic with a view to identifying areas for further research or service development. METHODS This was a review of the English language literature identified from Medline and Ovid and hand searches published between January 2000 and September 2012. Results were compiled according to physical, psychological and social domains of survivorship. RESULTS Of 182 studies identified, 22 met the inclusion criteria. There is a wide range of outcome measures used and a need for more objective measures. Unsurprisingly, survivors of extremity sarcoma typically demonstrate lower levels of physical functioning than healthy controls. In addition, survivors demonstrate a substantial psychological morbidity. CONCLUSIONS Services for survivors of extremity sarcoma should include rehabilitation and psychological support, sexual health services, expert pain management, and support to return to work.
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Affiliation(s)
- T Ng Kee Kwong
- University Hospital of North Tees, TS19 8PE, United Kingdom
| | - S Furtado
- Department of Orthopaedics, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
| | - C Gerrand
- North of England Bone and Soft Tissue Tumour Service, Department of Orthopaedics, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom.
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Jain P, Padole D, Bakshi S. Prevalence of acute neuropathic pain after cancer surgery: A prospective study. Indian J Anaesth 2014; 58:36-42. [PMID: 24700897 PMCID: PMC3968649 DOI: 10.4103/0019-5049.126788] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: Acute neuropathic pain (ANP) is an under-recognised and under-diagnosed condition and often difficult to treat. If left untreated, it may further transform into persistent post-operative chronic pain leading to a disability. Aims: This prospective study was undertaken on 300 patients to identify the prevalence of ANP in the post-operative period by using a neuropathic pain detection questionnaire tool. Methods: This is an open-label study in which patients with six different types of cancer surgeries (Thoracic, gastro-intestinal, gynae/urology, bone/soft-tissue, head and neck and breast subgroups-50 each) were included for painDETECT questionnaire tool on the 2nd and 7th day surgery. Results: This study found a 10% point prevalence of ANP. Analysis showed that 25 patients had ‘possible’ ANP, the maximum from urological cancer surgery (6) followed by thoracic surgery (5). Five patients were found to have ‘positive’ ANP including 2 groin node dissection, 2 hemipelvectomy and 1 oesophagectomy. Conclusion: Significant relationship between severity of post-operative pain was found with the occurrence of ANP in the post-operative period requiring a special attention to neuropathic pain assessment. Larger studies are required with longer follow-up to identify accurately the true prevalence and causative factors of ANP after surgery.
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Affiliation(s)
- Pn Jain
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Durgesh Padole
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sumitra Bakshi
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Recent developments of dual-energy CT in oncology. Eur Radiol 2014; 24:930-9. [DOI: 10.1007/s00330-013-3087-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/14/2013] [Accepted: 12/06/2013] [Indexed: 12/27/2022]
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Shoulder silhouette and axilla reconstruction with free composite elbow tissue transfer following interscapulothoracic amputation. J Plast Reconstr Aesthet Surg 2014; 67:81-6. [DOI: 10.1016/j.bjps.2013.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/15/2013] [Accepted: 10/06/2013] [Indexed: 12/13/2022]
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Schubert CD, Frassica FJ, Attar S, Deune EG. CASE REPORT Rotational Vascularized Tibiaplasty After Oncologic Resection and Major Wound Healing Problems: A Novel Technique. EPLASTY 2013; 13:e43. [PMID: 24015322 PMCID: PMC3750817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To describe a novel method to reconstruct, with a vascularized rotational tibiaplasty, a complex femoral defect in an adolescent. METHODS After a femoral osteosarcoma resection, allograft reconstruction, and chemotherapy, an 11-year-old girl developed recurrent thigh wound infections and femoral allograft osteomyelitis despite multiple operative interventions. At the age of 13, she presented to our center with a complex right thigh wound and an unstable lower extremity secondary to a segmental femoral loss. To reestablish thigh stability and function and to avoid amputation at the hip, the authors performed a rotational vascularized tibiaplasty. The tibia was rotated 180° with the pivot at the knee. The distal tibia was internally stabilized to the residual proximal femur. RESULTS Ten years later, the patient had a stable thigh, a functional hip, no evidence of infection or sarcoma, and a Toronto Extremity Salvage Score of 92.5 (minimal disability). CONCLUSIONS In this patient, the tibial rotationplasty provided a vascularized bone strut mimicking the resected femur; saved the hip; obviated an allograft bone; and created a functional, biologic, stable, and durable thigh that allowed full weight bearing on a prosthesis, with a low physical disability level. We conclude that, for patients with complex femoral defects, a vascularized rotational tibiaplasty should be considered a feasible option before amputation.
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Affiliation(s)
| | - Frank J. Frassica
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Md
| | - Samer Attar
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Md
| | - E. Gene Deune
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Md,Correspondence: E. Gene Deune, MD, c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A665, Baltimore, MD 21224-2780 (410-550-5400; fax: 410-550-2899; )
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Alamanda V, Crosby S, Archer K, Song Y, Schwartz H, Holt G. Amputation for extremity soft tissue sarcoma does not increase overall survival: A retrospective cohort study. Eur J Surg Oncol 2012; 38:1178-83. [DOI: 10.1016/j.ejso.2012.08.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/23/2012] [Indexed: 01/22/2023] Open
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Wu SP, Huang TC, Lin CC, Hui CF, Lin CH, Chen JY. Pardaxin, a fish antimicrobial peptide, exhibits antitumor activity toward murine fibrosarcoma in vitro and in vivo. Mar Drugs 2012; 10:1852-1872. [PMID: 23015777 PMCID: PMC3447341 DOI: 10.3390/md10081852] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 07/18/2012] [Accepted: 08/14/2012] [Indexed: 12/11/2022] Open
Abstract
The antitumor activity of pardaxin, a fish antimicrobial peptide, has not been previously examined in in vitro and in vivo systems for treating murine fibrosarcoma. In this study, the antitumor activity of synthetic pardaxin was tested using murine MN-11 tumor cells as the study model. We show that pardaxin inhibits the proliferation of MN-11 cells and reduces colony formation in a soft agar assay. Transmission electron microscopy (TEM) showed that pardaxin altered the membrane structure similar to what a lytic peptide does, and also produced apoptotic features, such as hollow mitochondria, nuclear condensation, and disrupted cell membranes. A qRT-PCR and ELISA showed that pardaxin induced apoptosis, activated caspase-7 and interleukin (IL)-7r, and downregulated caspase-9, ATF 3, SOCS3, STAT3, cathelicidin, p65, and interferon (IFN)-γ suggesting that pardaxin induces apoptosis through the death receptor/nuclear factor (NF)-κB signaling pathway after 14 days of treatment in tumor-bearing mice. An antitumor effect was observed when pardaxin (25 mg/kg; 0.5 mg/day) was used to treat mice for 14 days, which caused significant inhibition of MN-11 cell growth in mice. Overall, these results indicate that pardaxin has the potential to be a novel therapeutic agent to treat fibrosarcomas.
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Affiliation(s)
- Shu-Ping Wu
- Department of Aquaculture, National Taiwan Ocean University, Keelung 202, Taiwan; (S.-P.W.); (C.-H.L.)
| | - Tsui-Chin Huang
- Marine Research Station, Institute of Cellular and Organismic Biology, Academia Sinica, 23-10 Dahuen Rd., Jiaushi, Ilan 262, Taiwan;
| | - Ching-Chun Lin
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei 115, Taiwan;
| | - Cho-Fat Hui
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei 115, Taiwan;
- Authors to whom correspondence should be addressed; (J.-Y.C.); (C.-F.H.); Tel.: +886-920802111 (J.-Y.C.); +886-987836032 (C.-F.H.); Fax: +886-39871035
| | - Cheng-Hui Lin
- Department of Aquaculture, National Taiwan Ocean University, Keelung 202, Taiwan; (S.-P.W.); (C.-H.L.)
| | - Jyh-Yih Chen
- Marine Research Station, Institute of Cellular and Organismic Biology, Academia Sinica, 23-10 Dahuen Rd., Jiaushi, Ilan 262, Taiwan;
- Authors to whom correspondence should be addressed; (J.-Y.C.); (C.-F.H.); Tel.: +886-920802111 (J.-Y.C.); +886-987836032 (C.-F.H.); Fax: +886-39871035
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Onesti JK, Mascarenhas CR, Chung MH, Davis AT. Isolated metastasis of colon cancer to the scapula: is surgical resection warranted? World J Surg Oncol 2011; 9:137. [PMID: 22029634 PMCID: PMC3222610 DOI: 10.1186/1477-7819-9-137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 10/26/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Distant metastases from colon cancer spread most frequently to the liver and the lung. Risk factors include positive lymph nodes and high grade tumors. Isolated metastases to the appendicular skeleton are very rare, particularly in the absence of identifiable risk factors. CASE REPORT The patient was a 55 year old male with no previous personal or family history of colon cancer. Routine screening revealed a sigmoid adenocarcinoma. He underwent resection with primary anastomosis and was found to have Stage IIA colon cancer. He declined chemotherapy as part of a clinical trial, and eight months later was found to have an isolated metastasis in his right scapula. This was treated medically, but grew to 12 × 15 cm. The patient underwent a curative forequarter amputation and is now more than four years from his original colon surgery. DISCUSSION Stage IIA colon cancers are associated with a high five year survival rate, and chemotherapy is not automatically given. If metastases occur, they are likely to arise from local recurrence or follow lymphatic dissemination to the liver or lungs. Isolated skeletal metastases are quite rare and are usually confined to the axial skeleton. To our knowledge, this is the first reported case of an isolated scapular metastasis in a patient with node negative disease. The decision to treat the recurrence with radiation and chemotherapy did not reduce the tumor, and a forequarter amputation was eventually required. CONCLUSION This case highlights the importance of adequately analyzing the stage of colon cancer and offering appropriate treatment. Equally important is the early involvement of a surgeon in discussing the timing of the treatment for recurrence. Perhaps if the patient had received chemotherapy or earlier resection, he could have been spared the forequarter amputation. The physician must also be aware of the remote possibility of an unusual presentation of metastasis in order to pursue timely work up.
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Affiliation(s)
- Jill K Onesti
- GRMEP/MSU General Surgery Residency Program, 1000 Monroe Ave. NW, Grand Rapids, MI 49503, USA
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Parsons CM, Pimiento JM, Cheong D, Marzban SS, Gonzalez RJ, Johnson D, Letson GD, Zager JS. The role of radical amputations for extremity tumors: a single institution experience and review of the literature. J Surg Oncol 2011; 105:149-55. [PMID: 21837679 DOI: 10.1002/jso.22067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 07/24/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Major amputations are indicated for advanced tumors when limb-preservation techniques have been exhausted. Radical surgery can result in significant palliation and possible cure. METHODS We identified 40 patients who underwent forequarter (FQ) or hindquarter (HQ) amputations between May 2000 and January 2011. Patient demographics, tumor-related factors, and outcomes were reviewed. RESULTS There were 30 FQ and 10 HQ amputations. The most common diagnoses were sarcoma (55%) and squamous cell carcinoma (25%). Patients presented with primary tumors (35%), regional recurrence (57.5%), or unresectable limb metastatic disease (7.5%). Presenting symptoms included fungating wounds (35%), intractable pain (78%), and limb dysfunction (65%). Operations were performed with curative intent (10%), curative/palliative intent (70%), or palliation alone (20%). Wound complications occurred in 35%. Pain was improved in 78% of patients following surgery. Despite a 91% negative margin rate, 79% of patients recurred either locally or distantly. Median overall survival was 10.9, 13.2, and 3.4 months in the curative, curative/palliative, and palliative groups, respectively. CONCLUSIONS In the absence of conservative options, major amputations are indicated for the management of advanced tumors. These operations can be performed safely, resulting in effective palliation of debilitating symptoms. While recurrence rates remain high, some patients can achieve prolonged survival.
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Granda-Cameron C, Hanlon AL, Lynch MP, Houldin A. Experience of newly diagnosed patients with sarcoma receiving chemotherapy. Oncol Nurs Forum 2011; 38:160-9. [PMID: 21356654 DOI: 10.1188/11.onf.160-169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine symptom distress and quality of life (QOL) in newly diagnosed patients with sarcoma receiving chemotherapy. DESIGN Pilot study; descriptive, quantitative. SETTING Urban community cancer center in the northeastern United States. SAMPLE 11 newly diagnosed patients with sarcoma. METHODS Participants completed the Edmonton Symptom Assessment Scale and the Functional Assessment of Cancer Therapy-General at baseline and on days 1, 15, and 21 of their chemotherapy treatment. MAIN RESEARCH VARIABLES Symptom distress and QOL. FINDINGS Fatigue was the most prevalent and pervasive symptom. Anxiety, well-being, lack of appetite, drowsiness, and depression were the most commonly reported symptoms during chemotherapy. QOL was negatively affected. The lowest mean score reported was for functional well-being. Outcome profiles for symptom distress increased over time, whereas QOL profiles decreased over time. Exploratory analyses of age, race, sex, and diagnosis group suggested differences that warrant further study. CONCLUSIONS Overall, increasing symptom distress and reduced QOL over time were reported by patients with sarcoma during chemotherapy. Exploratory analysis by demographic variables and treatment group suggested the need for further research of predictors for symptom distress and QOL. IMPLICATIONS FOR NURSING Clinical and research implications included the need for better understanding about symptom distress and QOL predictors in patients with sarcoma, as well as the evaluation of interventions directed to address this population's specific needs.
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Affiliation(s)
- Clara Granda-Cameron
- Pain and Supportive Care Program, Joan Karnell Cancer Center, Pennsylvania Hospital, Philadelphia, USA
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Wang ML, Ballard BL, Kulidjian AA, Abrams RA. Upper extremity reconstruction with a humeral tumor endoprosthesis: a novel salvage procedure after multiple revisions of total shoulder and elbow replacements. J Shoulder Elbow Surg 2011; 20:e1-8. [PMID: 21134657 DOI: 10.1016/j.jse.2010.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 07/15/2010] [Accepted: 07/21/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Mark L Wang
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA.
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Daigeler A, Chromik AM, Haendschke K, Emmelmann S, Siepmann M, Hensel K, Schmitz G, Klein-Hitpass L, Steinau HU, Lehnhardt M, Hauser J. Synergistic effects of sonoporation and taurolidin/TRAIL on apoptosis in human fibrosarcoma. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1893-1906. [PMID: 20870344 DOI: 10.1016/j.ultrasmedbio.2010.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/30/2010] [Accepted: 08/13/2010] [Indexed: 05/29/2023]
Abstract
Sonodynamic therapy, in combination with ultrasound contrast agents, proved to enhance the uptake of chemotherapeutics in malignant cells. HT1080 fibrosarcoma cells were treated in vitro with a combination of ultrasound SonoVue™-microbubbles and taurolidine (TRD) plus tumor necrosis factor related apoptosis inducing ligand (TRAIL). Apoptosis was measured by TdT-mediated dUTP-biotin nick end labelling (TUNEL) assay and fluorescence activated cell sorting (FACS) analysis. Gene expression was analysed by RNA-microarray. The apoptotic effects of TRD and TRAIL on human fibrosarcoma are enhanced by sonodynamic therapy and additional application of contrast agents, such as SonoVue™ by 25%. A broad change in the expression of genes related to apoptotic pathways is observed when ultrasound and microbubbles act synchronously in combination with the chemotherapeutics (e.g. BIRC3, NFKBIA and TNFAIP3). Some of these genes have already been proven to play a role in programmed cell death in human fibrosarcoma (HSPA1A/HSPA1B, APAF1, PAWR, SOCS2) or were associated with sonication induced apoptosis (CD44). Further studies are needed to explore the options of sonodynamic therapy on soft tissue sarcoma and its molecular mechanisms.
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Affiliation(s)
- Adrien Daigeler
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Unfallkrankenhaus, Ludwigshafen, Germany.
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Kalson NS, Gikas PD, Aston W, Miles J, Blunn G, Pollock R, Skinner J, Briggs TWR, Cannon SR. Custom-made endoprostheses for the femoral amputation stump: an alternative to hip disarticulation in tumour surgery. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 2010; 92:1134-7. [PMID: 20675760 DOI: 10.1302/0301-620x.92b8.23682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Disarticulation of the hip in patients with high-grade tumours in the upper thigh results in significant morbidity. In patients with no disease of the proximal soft tissue a femoral stump may be preserved, leaving a fulcrum for movement and weight-bearing. We reviewed nine patients in whom the oncological decision would normally be to disarticulate, but who were treated by implantation of an endoprosthesis in order to create a functioning femoral stump. The surgery was undertaken for chondrosarcoma in four patients, pleomorphic sarcoma in three, osteosarcoma in one and fibrous dysplasia in one. At follow-up at a mean of 80 months (34 to 132), seven patients were alive and free from disease, one had died from lung metastases and another from a myocardial infarction. The mean functional outcome assessment was 50 (musculoskeletal tumor society), 50 and 60 (physical and mental Short-form 36 scores). Implantation of an endoprosthesis into the stump in carefully selected patients allows fitting of an above-knee prosthesis and improves wellbeing and the functional outcome.
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Affiliation(s)
- N S Kalson
- Medical School, The Stopford Building, Manchester University, Oxford Road, Manchester, M13 9PT, UK.
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Steinau HU, Daigeler A, Langer S, Steinsträsser L, Hauser J, Goertz O, Lehnhardt M. Limb salvage in malignant tumors. Semin Plast Surg 2010; 24:18-33. [PMID: 21286302 PMCID: PMC2887000 DOI: 10.1055/s-0030-1253240] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Limb-sparing resection and reconstruction has become the treatment of choice in extremity malignancies, as amputation does not provide better long-term survival rates or functional advantages. R0 resection, the removal of the tumor in sano, remains the prerequisite and most important oncologic parameter to avoid local recurrence. Successful treatment requires the combination of surgical eradication and the patient's specific functional and aesthetic rehabilitation. Our clinical rationale resulting from more than 2000 cases will be demonstrated. The problematic aspects of different tumor entities and the locoregional clearance of lymphatic pathways will be discussed. Differential diagnosis and multimodality treatment in high-volume tumor centers is likely to achieve superior oncologic statistics. Long-term survivors after microsurgical reconstructions and possible secondary malignancies will be addressed.
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Affiliation(s)
- Hans-Ulrich Steinau
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Adrien Daigeler
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Stefan Langer
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Lars Steinsträsser
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Jörg Hauser
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Ole Goertz
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Markus Lehnhardt
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
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