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2003, Number 2

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Cir Cir 2003; 71 (2)

Is there an indication for palliative surgical procedure of shoulder and upper limb malignancies?

Luna-Ortiz K, Maafs-Molina E, Herrera-Gómez A Barrera-Franco JL

Language: English
References: 25
Page: 102-106
PDF size: 45.61 Kb.


ABSTRACT

Aims: Major amputation is not a frequent procedure at present, however, there is a group of patients still considered for these treatments. Our objective was to evaluate the results of this surgical intervention as well as to evaluate morbidity, local control, free disease, and palliation. Methods: The study included 57 patients on whom interscapulothoracic disarticulation (STDI) was carried out at the Instituto Nacional de Cancerología were (Mexico City) from 1974 to 1993. Patients with oncologic pathology were operated with a palliative aims. Twenty eight male and twenty nine female patients were found with average age of 44 years (range: 13 to 79 years). Clinical situation was characterized by tumor (100%), pain (46%), functional incapacity (39%), ulceration (32%), and bleeding (9%), Karnofsky 80% (range, 50 to 100). Time of evolution was 25 months (range: 1-121 months) and size was > 10 cm in 86% of cases. Results: Postoperative complications were present in ten, followed by patients follow infection in five cases, hematoma in the upper lung lobe in two and femoral thrombosis, skin wound necrosis, and bleeding in one case each. Palliation was evaluated to eliminate tumoral load, ulceration, bleeding, functional incapacity, and pre- and postoperative pain. Global survival was 12 months (range, 1-139 months). Conclusions: Interscapulothoracic disarticulation is an infrequently performed surgery with low morbidity and mortality, low recurrence, no effect on survival, and excellent palliative results.


REFERENCES

  1. Keevil JJ. Ralph Cuming and the interscapulothoracic amputation in 1808. J Bone Joint Surg (Br) 1949;31-B:589-595.

  2. Crosby AB. The first operation on record for removal of the entire arm, scapula and three-fourths of the clavicle by Dixi Crosby. Concord, NH, USA Republican Press Assn Med Rec 1875;10:753.

  3. Pack GT, McNeer G, Coley BL. Interscapulothoracic amputation for malignant tumors of the upper extremity. Surg Gynecol Obstet 1942;74:161-175.

  4. Pack GI. Major exarticulations for malignant neoplasms of the extremities. Interscapulothoracic amputation, hip-joint disarticulation and interileo-abdominal amputation. J Bone Joint Surg 1956; 38:249-262.

  5. Eilber FR, Mirra JJ, Grant TT, Weisenburger T, Morton DL. Is amputation necessary for sarcomas? A seven year experience with limb salvage. Ann Surg 1980;192:431-438.

  6. Eilber FR, Morton DL, Eckardt J, Grant TT, Weisenburger T. Limb salvage for skeletal and soft tissue sarcomas. Multidisciplinary preoperative therapy. Cancer 1984;53:2579-2584.

  7. Lindberg RD, Martin RG, Romsdahl MM, Barkley HT. Conservative surgery and postoperative radiotherapy in 300 adults with soft tissue sarcomas. Cancer 1981;47:2391-2397.

  8. Doherty MA, Rodger A, Langiands-AO. Sarcoma of bone following therapeutic irradiation for breast carcinoma. Int J Radiat Oncol Biol Phys 1986;12:103-106.

  9. Souba WW, McKenna RJ Jr, Meis J, Benjamin R, Raymound AK, Mountain CF. Radiation induce sarcomas of the chest wall. Cancer 1986;57:610-615.

  10. Davison T, Westbury G, Harmer CL. Radiation induced soft tissue sarcoma. Br J Surg 1986;73:308-309.

  11. Stafford ES, Rainey WG Jr. Radical transthoracic forequarter amputation. Ann Surg 1958;148:699.

  12. Roth JA, Sugarbaker PH, Baker AR. Radical forequarter amputation with chest wall resection. Ann Thorac Surg 1984;37:423-427.

  13. Hovius SE, Hofman A, Van-Urk H, Van-Der-Meulen Jc. Acute management of traumatic forequarter amputation: case report. J Trauma 1991;31:1415-1419.

  14. Ebraheim NA, Pearlstein SR, Savolaine ER, Gordon SL, Jackson WT, Corray T. Scapulothoracic dissociation (closed avulsion of the scapula, subclavian artery, and brachial plexus): a newly recognized variant, a new classification, and a review of the literature and treatment options. J Orthop Trauma 1987;1:18-23.

  15. Lusk MD, Kline DG, García CA. Tumors of the braquial plexus. Neurosurgery 1987;21:439-453.

  16. American Joint Committee on Cancer (AJCC) staging manual. 5th ed. Philadelphia, PA, USA: Lippincott-Raven;1998.

  17. Merimsky O, Kollender Y, Inbar M, Lev-Chelouche D, Gutman M, Issakov J, Mazeh D, Shabat S, Bickels J, Meller I. Is forequarter amputation justified for palliation of intractable cancer symptoms? Oncology 2001;60:55-59.

  18. Merimsky O, Kollender Y, Bickels J, Inbar M, Nirkin A, Issakov J, Chaitchik S, Meller I. Amputation of the lower limb as palliative treatment for debilitating musculoskeletal cancer. Oncol Rep 1997;4: 1059-1062.

  19. Higinbotham NL, Marcove RC, Casson P. Hemipelvectomy: a clinical study of 100 cases with five years follow-up on 60 patients. Surgery 1966;59:706-710.

  20. Bhagia SM, Elek EM, Grimer RJ, Carter SR, Tillman RM. Forequarter amputation for high grade malignant tumors of the shoulder girdle. J Bone Joint Surg (Br) 1997;79:924-926.

  21. Stephenson RB, Kaufer H, Hankin RM. Partial pelvic resection as an alternative to hindquarter amputation for skeletal neoplasms. Clin Orthop 1989;242:201-211.

  22. Katz J, Melzack R. Pain memories in phantom limbs: review and clinical observations. Pain 1990;43:319-336.

  23. Ham SJ, Hoekstra HJ, Koops HS, Eisma WH, Oldhoff J. The interscapulothoracic amputation in the treatment of malignant diseases of the upper extremity with a review of the literature. Eur J Surg Oncol 1993;19:543-548.

  24. Lienard D, Lejeune EJ. Therapeutic value of scapular and pelvic girdle disarticulations in sarcoma. Eur J Surg Oncol 1987;13:231-237.

  25. Fanous N, Didolkar MS, Holyoke ED, Elias EG. Evaluation of forequarter amputation in malignant diseases. Surg Gynecol Obstet 1976;142:381-384.




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