Quality of Life and Functional Outcome of Patients Treated with Revision Limb Salvage Surgery and Amputation: A Cross-Sectional Study
Case Report | Volume 5 | Issue 2 | JBST May – August 2019 | Page 11-14| M S Satish, Srinivasan Vijay, Anand Raja, Surendran Veeraiah. DOI: 10.13107/jbst.2019.v05i02.428
Author M S Satish, Srinivasan Vijay, Anand Raja, Surendran Veeraiah
Department of Physiotherapist, Cancer Institute (WIA), Chennai, Tamil Nadu, India,
Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India,
Department of Psycho-Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India.
Address of Correspondence
Dr. M S Satish,
Department of Physiotherapist, Cancer Institute(WIA), Adyar, Chennai, Tamil Nadu, India.
Context: Despite the advances in surgical treatments and chemotherapy, obtaining an optimal outcome in the treatment of musculoskeletal tumors or sarcomas is still quite challenging. This can be managed by improving various factors such as survival and recurrence rate, longevity of the prosthesis, functional outcome, and quality of life (QOL) of patients. However, not much attention has been given to this issue in India.
Aims: The aim of the study was to examine the QOL and functional outcome of musculoskeletal cancer patients who were treated with revision limb salvage surgery (LSS) and those who underwent above-knee (AK) amputation followed by rehabilitation with Akprosthesis.
Settings and Design: A cross-sectional study was carried out between May 2015 and April 2016 at Physiotherapy Out patient Department of Cancer Institute, Chennai.
Materials and Methods: Thirty-two patients aged between 15and 60 years, treated with revision LSS (n=15) and those rehabilitated with prosthesis after AK amputation (n=17)were assessed for QOL and functional outcome. Cancer Institute QOL questionnaire was used to assess QOL and Musculoskeletal Tumor Society score was used to find the functional outcome of these patients.
Statistical analysis: Descriptive statistics, student’s t-test, and Chi-square test were used to analyze the data using SPSS version 13.
Results: The revision LSS patients were found to have a better functional outcome as well as QOL than the amputees. Yet another aspect of QOL, namely, fear of recurrence was much lesser among AK amputees than revision LSS patients.
Conclusions: The findings of this study imply that revision LSS has higher advantages in terms of functional outcome and QOL of patients compared to amputation, though patients treated with revision LSS were found to have increased fear of recurrence and pain than the amputees.
Keywords: Revision limb salvage surgery, quality of life, functional outcome, amputation, musculoskeletal tumor.
1. Chauhan A, Joshi GR, Chopra BK, Ganguly M, Reddy GR. Limb salvage surgery in bone tumors: A retrospective study of 50 cases in a single center. Indian J Surg Oncol 2013;4:248-54.
2. Allison DC, Carney SC, Ahlmann ER, Hendifar A, Chawla S, Fedenko A, et al. A meta-analysis of osteosarcoma outcomes in the modern medical era. Sarcoma 2012;2012:704872.
3. Reddy KI, Wafa H, Gaston CL, Grimer RJ, Abudu AT, Jeys LM, et al. Does amputation offer any survival benefit over limb salvage in osteosarcoma patients with poor chemonecrosis and close margins? Bone Joint J 2015;97-B:115-20.
4. Yoshida Y, Osaka S, Kojima T, Taniguchi M, Osaka E, Tokuhashi Y, et al. Revision of tumor prosthesis of the knee joint. Eur J Orthop Surg Traumatol2012;22:387-94.
5. Davidson JH, Jones LE, Cornet J, Cittarelli T. Management of the multiple limb amputee. DisabilRehabil2002;24:688-99.
6. Zidarov D, Swaine B, Gauthier-Gagnon C. Quality of life of persons with lower-limb amputation during rehabilitation and at 3-month follow-up. Arch Phys Med Rehabil2009;90:634-45.
7. Robert RS, Ottaviani G, Huh WW, Palla S, Jaffe N. Psychosocial and functional outcomes in long-term survivors of osteosarcoma: A comparison of limb-salvage surgery and amputation. Pediatr Blood Cancer 2010;54:990-9.
8. Aksnes LH, Bauer HC, Jebsen NL, Follerås G, Allert C, Haugen GS, et al. Limb-sparing surgery preserves more function than amputation: A Scandinavian sarcoma group study of 118 patients. J Bone Joint Surg Br 2008;90:786-94.
9. Zahlten-Hinguranage A, Bernd L, Ewerbeck V, Sabo D. Equal quality of life after limb-sparing or ablative surgery for lower extremity sarcomas. Br J Cancer 2004;91:1012-4.
10. Weddington WW Jr.,Segraves KB, Simon MA. Psychological outcome of extremity sarcoma survivors undergoing amputation or limb salvage. J Clin Oncol 1985;3:1393-9.
11. Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am 1997;44:973-89.
12. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin OrthopRelat Res 1993;286:241-6.
13. Vidhubala E, Kannan RR, Mani SC, Karthikesh K, Muthuvel R, Surendran V, et al. Validation of quality of life questionnaire for patients with cancer Indian scenario. Indian J Cancer 2005;42:138-44.
14. Eiser C, Darlington AS, Stride CB, Grimer R. Quality of life implications as a consequence of surgery: Limb salvage, primary and secondary amputation. Sarcoma 2001;5:189-95.
15. Ruggieri P, Mavrogenis AF, Mercuri M. Quality of life following limb-salvage surgery for bone sarcomas. Expert Rev Pharmacoecon Outcomes Res 2011;11:59-73.
16. Mason GE, Aung L, Gall S, Meyers PA, Butler R, Krüg S, et al. Quality of life following amputation or limb preservation in patients with lower extremity bone sarcoma. Front Oncol 2013;3:210.
17. Hopyan S, Tan JW, Graham HK, Torode IP. Function and upright time following limb salvage, amputation, and rotationplasty for pediatric sarcoma of bone. J PediatrOrthop2006;26:405-8.
18. Davis AM, Devlin M, Griffin AM, Wunder JS, Bell RS. Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: A matched case-control study. Arch Phys Med Rehabil1999;80:615-8.
19. Malek F, Somerson JS, Mitchel S, Williams RP. Does limb-salvage surgery offer patients better quality of life and functional capacity than amputation? Clin OrthopRelat Res 2012;470:2000-6.
20. Renard AJ, Veth RP, Schreuder HW, van Loon CJ, Koops HS, van Horn JR, et al. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol 2000;73:198-205.
21. Ginsberg JP, Rai SN, Carlson CA, Meadows AT, Hinds PS, Spearing EM, et al. A comparative analysis of functional outcomes in adolescents and young adults with lower-extremity bone sarcoma. Pediatr Blood Cancer 2007;49:964-9.
22. Bekkering WP, Vliet Vlieland TP, Koopman HM, Schaap GR, Bart Schreuder HW, Beishuizen A, et al. Functional ability and physical activity in children and young adults after limb-salvage or ablative surgery for lower extremity bone tumors. J Surg Oncol 2011;103:276-82.
23. Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am 1994;76:649-56.
|Dr. M S Satish||Dr. Srinivasan Vijay||Dr. Anand Raja||Dr. Surendran Veeraiah|
|How to Cite this article: Satish M S, Vijay S, Raja A, Surendran V. Quality of Life and Functional Outcome of Patients Treated with Revision Limb Salvage Surgery and Amputation: A Cross-Sectional Study. Journal of Bone and Soft Tissue Tumors May-August 2019;5(2): 11-14.|