# Outcomes and Prognostic Factors in Tumor-Related Amputations: A Retrospective Cohort Study of 132 Cases over Two Decades

## TL;DR

This study examines tumor-related amputations over two decades, finding that hand/foot amputations are linked to better survival and that local recurrence is a key survival predictor.

## Contribution

The study provides new insights into survival and recurrence differences between primary and secondary amputations and amputation levels in musculoskeletal oncology.

## Key findings

- Hand/foot amputations showed significantly better survival compared to major amputations.
- Local recurrence was the only significant predictor of overall survival.
- Primary and secondary amputations had comparable survival outcomes.

## Abstract

Background: Despite advancements in limb-sparing surgery (LSS), adjuvant therapies, and imaging techniques, amputations remain necessary in certain cases, including locally advanced tumors, inadequate resections, or palliative scenarios. This study aims to provide an overview of tumor-related amputations, comparing primary and secondary amputations in terms of survival, recurrence, and surgical outcomes. Methods: A retrospective cohort study of 132 patients undergoing tumor-related amputations between 2004 and 2023 at a tertiary care center was conducted. Patients were stratified by amputation level (major vs. hand/foot) and timing (primary vs. secondary). Kaplan–Meier survival and multivariate regression analysis identified prognostic factors. Results: Major amputations accounted for 77% of cases, while 23% involved the hands or feet. Primary amputations constituted 55% of procedures, and 45% were secondary interventions. Overall survival was 123 months (95% CI, 105–142), with a 5-year survival rate of 66% and a 10-year survival rate of 53%, respectively. Hand/foot amputations showed superior survival compared to major amputations (p = 0.032). Local recurrence emerged as the only significant predictor of overall survival (p = 0.033). Conclusions: Tumor-related amputations remain crucial in musculoskeletal oncology. Survival outcomes are comparable between primary and secondary amputations, but hand/foot amputations are associated with improved survival. Achieving local control is critical, underscoring the need for precise surgical planning.