Limb-sparing surgery may not provide a bone cancer patient with a better quality of life than amputation, suggests a new review.
Published in the journal Cancer, the analysis indicates that patients and physicians should rethink the pros and cons of limb-sparing surgery and amputation.
Patients with tumours of the bone or soft tissue in their arms and legs require surgery to remove their cancer.
Canadian researchers Ronald Barr, of McMaster University, and Jay Wunder, 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, in order to compare the costs and benefits of amputation compared with limb-sparing surgery in these patients.
They 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.
The researcher also say that, particularly for patients with lower limb bone sarcomas, limb salvage does not provide a better quality of life to patients than amputation.
According to them, 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, say the researchers, 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 versus 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.
In their study report, the authors write that more studies are required 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.