Limb Salvage Surgery versus Amputation for Extremity Soft Tissue Sarcomas: A Systematic Review of Oncologic and Functional Outcomes

Abstract

Introduction: The standard surgical approach for extremity soft tissue sarcomas has shifted from amputation to limb salvage surgery (LSS), which consists of wide local excision often combined with radiation. This review compares the outcomes of these two approaches.

Methods: A systematic review of large, prospective and retrospective cohort studies was performed. We included studies that compared LSS (with or without radiotherapy) to amputation for primary, high-grade extremity soft tissue sarcomas. Primary outcomes were overall survival and local recurrence.

Results: The analysis of the literature showed no significant difference in overall survival or disease-specific survival between patients undergoing LSS and those undergoing amputation, provided that negative surgical margins were achieved with LSS. Local recurrence rates were slightly higher with LSS but did not impact overall survival. Functional outcomes were superior with LSS.

Discussion: The principle of limb salvage is oncologically safe and is the cornerstone of modern sarcoma care. Its success depends on achieving wide negative margins, which is often facilitated by a multidisciplinary team approach and the use of adjuvant radiation.

Conclusion: Limb salvage surgery offers equivalent survival outcomes to amputation for extremity soft tissue sarcomas, with superior functional results.