# Comparative Outcomes of Limb Salvage Surgery Versus Amputation in Osteosarcoma: A Five-Year Follow-Up Study From a Tertiary Care Center

## TL;DR

This study compares limb salvage surgery and amputation for osteosarcoma, finding better survival and quality of life with limb salvage.

## Contribution

Provides five-year comparative outcomes of limb salvage surgery versus amputation for osteosarcoma in a low-resource setting.

## Key findings

- Limb salvage surgery showed higher five-year survival (83.8%) compared to amputation (62.5%).
- Limb salvage patients had better functional and quality of life scores.
- Limb salvage had more frequent negative surgical margins without increased complications.

## Abstract

Background: The most prevalent primary malignant bone tumor that affects teenagers and young adults is osteosarcoma. Limb salvage surgery (LSS) has replaced amputation as the surgical treatment of choice, but still, there is a dearth of comparison data from low- and middle-income environments.

Objective: To compare the outcomes of limb salvage surgery versus amputation in patients with osteosarcoma over five years.

Methodology: The Department of Orthopaedic Surgery at Lady Reading Hospital/MTI, Peshawar, Pakistan, carried out this retrospective comparative study during five years (2018-2023). In all, 61 patients with histologically verified non-metastatic osteosarcoma had either amputation (n=24) or limb salvage surgery (n=37). Data on therapy, histopathology, clinical, and demographics were examined. The EORTC QLQ-C30 questionnaire was used to measure quality of life, and the Musculoskeletal Tumor Society (MSTS) score was used to measure functional outcomes. The Kaplan-Meier method was used to analyze survival.

Results: LSS patients had a significantly higher five-year survival rate (83.8%) compared to amputation (62.5%; p=0.048). Functional scores (MSTS) and quality of life (QLQ-C30) were markedly better in the LSS group (p=0.002). Local recurrence and surgical complications were comparable between groups. Surgical margins were more frequently negative in the LSS group (p=0.031).

Conclusion: Limb salvage surgery suggested a clear advantage in terms of survival, limb function, and quality of life without increasing recurrence or complications. These findings support wider adoption of LSS in appropriately selected osteosarcoma patients, even within resource-constrained healthcare environments.