Who still requires upper extremity amputation for sarcoma? A 10-year single-centre analysis of indications, perioperative and survival outcomes.

INTRODUCTION: Limb-salvage surgery is standard for extremity sarcoma, and upper extremity amputation has become uncommon. Contemporary data on who still requires it are scarce. We characterised the indications for, and the perioperative and survival outcomes of, upper extremity amputation for sarcoma at a tertiary sarcoma centre. MATERIALS AND METHODS: Retrospective single-centre series of all patients undergoing upper extremity amputation for histologically confirmed bone or soft tissue sarcoma (2010-2019), classified by indication (primary versus after previous limb-salvage treatment). Overall survival was estimated from amputation by the Kaplan-Meier method; groups were compared descriptively (Fisher exact and Mann-Whitney U tests). RESULTS: Twenty-one patients were included (median age 62 years; 71% male; 62% soft tissue, 38% bone sarcoma; 71% high grade). Amputation was very proximal (forequarter 48%, above-elbow 43%) and performed as primary treatment in 9 patients (43%) and as salvage after previous limb-salvage treatment in 12 (57%); local recurrence was the most frequent disease state (48%). Median hospital stay was 16 days; transfusion was required in 48% and phantom limb pain in 43%. Wound complications occurred in 2 patients (10%) and in-hospital mortality in 1 (5%). At a median follow-up of 76.9 months, 5-year overall survival was 41%. CONCLUSION: Upper extremity amputation for sarcoma is uncommon but remains necessary, most often as salvage for local recurrence after initial limb-sparing treatment, and can be performed safely within a specialised sarcoma centre.