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 focally advanced disease that has a lready failed to respond to radiation therapy, chemotherapy and limited sur gery. Methods: Twelve patients with advanced malignant tumors involving the shoulder girdle or the proximal humerus underwent forequarter amputation ( FQA) for palliative purposes. The tumor-related local problems were severe pain, limb dysfunction, tumor fungation, bleeding (requiring emergency FQA in one case) and infection. The preoperative Karnofsky performance status ( KPS) in our series ranged from 30 to 70%. Results: No perioperative mortali ty 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 of the 1 2 patients. Overall, quality of life was reported to be at least moderately improved by 2 out of 3 patients. Survival was measured in months (3-24 mon ths), but ultimately had no meaning since the procedure was palliative. Lun g metastases were the dominant cause of death in our patients. Conclusions: The results of FQA in our series point to its feasibility and the gain in quality of life and performance status in severely ill patients with advanc ed malignancies. Local symptoms and signs were controlled, and quality of l ife was restored. Copyright (C) 2001 S. Karger AG, Basel.