Also known as limb-sparing surgery, it is a specialised type of surgery where the diseased bone or tumour is removed while preserving nearby tendons, nerves and blood vessels, to achieve maximal function and appearance. Sometimes, there is the removal of bone which is then replaced either with another bone (from another part of the body/another person) or a man-made prosthesis. The primary goal of the surgery is to restore & maintain stability and ambulation which includes replacing lost functional units. This surgery is an alternative to amputation.
In cases of bone cancer or soft-tissue cancer, the surgeon needs to operate to excise the tumour. The decision to salvage the injured limb is multifactorial (where the tumour is, how big is it, has it grown into nearby structures or spread to other areas) & should be decided after reviewing individual cases, guided by definitive indicators
How is the surgery performed?
The surgery is performed in 3 stages:
- Surgeons remove cancer and a margin (approximately an inch) of healthy tissue to cure low-grade tumours of bone and its components. In a high-grade tumour, they remove muscle, bone and other tissues affected by the tumour. In soft-tissue sarcomas, surgeons remove the tumour, lymph nodes, or tissues to which cancer has spread.
- Implantation of a bone or prosthesis if necessary – The replacement is made with synthetic metal rods or plates (prosthesis), pieces of bone taken from the patient’s own body(autologous transplant) or pieces of bone removed from a donor body (cadaver), which is frozen until needed (allograft). Other procedures that might be performed are compound flaps with different tissue components, skeletal reconstruction, tendon transfer/reconstruction. Surgeon checks the placement of the implant and closes the operating site
- Chemotherapy and radiation may be given, depending on the extent of cancer. Limb salvage surgery in combination with chemotherapy & radiation is the choice of treatment in slow spreading cancer. The hospital stay is typically 2 weeks, where the patient is on a cocktail of antibiotics and anticoagulants that help prevent blood clots and infection. Physiotherapy is advised and depending on each patient, muscle strengthening, continuous passive motion (CPM) and ROM exercises are started from the first-day post operation.
Are there any risks associated with the surgery?
- Superficial or deep infections
- Blood loss or anaemia from the surgery
- Loosening, reposition or breakage of implants
- Contractures (permanent tightening of the joints)
- Non-union of the bones
- Limb-length discrepancy
- Rapid loss of blood flow or sensation in the affected limb
- Amputation may still occur if they are complications post-surgery
Despite the complications, 95% of most sarcoma cases are treated with limb-salvage surgery, as the psychological and physical effects of amputation are not easily accepted by the patient. With limb salvage patient is able to daily activities easily and feels more confident in life. However, limb salvage is more extensive as well as it being a costlier treatment option. With the help of occupational therapy and psychological support, people who’ve had limb-salvage surgery are able to live fully functional lives with no reduction in quality of life.