Is Forequarter Amputation Justified For
Palliation of Intractable Cancer Symptoms?
Background: Limb sparing surgery has replaced the radical surgical approach for treating limb sarcomas in most cases. Amputation has been advocated as a palliative procedure for symptomatic locally advanced disease that had already failed to respond to radiation therapy, chemotherapy and limited surgery.
Patients: Twelve patients with advanced malignant tumors involving the shoulder girdle or the proximal humerus underwent forequarter amputation for palliative purpose. The tumor-related local problems were severe pain, limb dysfunction, tumor fungation, bleeding (requiring emergency FQA in one case), and infection. The pre-operative Karnofsky’s performance status (KPS) in our series ranged from 30% to 70%.
Results: No perioperative mortality was observed. The morbidity was well tolerated by the patients. The KPS improved in most of the patients, and was assessed as 90-100% in 9/12. Overall, the quality of life was reported to be at least moderately improved by 2/3 of the patients. Survival was measured in months (3-24), but eventually had no meaning since the procedure was palliative. Lung metastases were the dominant cause of the death in our patients.
Conclusions: The results of FQA in our series point to the feasibility and gain in quality of life and performance status in severely ill patients with advanced malignancies. Local symptoms
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