OUTCOMES OF THE COMBINED ANTEROPOSTERIOR APPROACH FOR FOREQUARTER AMPUTATION IN SHOULDER GIRDLE TUMORS.

Authors

  • Imran Khan Hayatabad medical Complex Peshawar
  • Zeeshan Khan Associate Professor of Orthopaedic surgery, Hayatabad Medical Complex Peshawar
  • Israr Ahmad Associate Professor of Orthopaedic surgery, Hayatabad Medical Complex Peshawar
  • Arif Khan Professor of Orthopaedic surgery, Hayatabad Medical Complex Peshawar
  • Muhammad Saeed Assistant Professor of Orthopaedic surgery, Hayatabad Medical Complex Peshawar

DOI:

https://doi.org/10.55519/JAMC-01-9006

Abstract

Background: Forequarter amputation (FQA) is the surgical treatment of choice for tumours in the upper extremity and shoulder girdle that infiltrate the neurovascular bundle, shoulder joint and muscles of the shoulder girdle in non-salvageable cases. In both curative and palliative settings, FQA can serve as an effective oncological treatment for local control of tumour. Methods: All patients who underwent FQA in our unit from January 2016 till August 2019 for oncological indications were included in our study and their clinical outcomes were calculated. Results: Thirteen patients were included in the study including 8 male patients. Mean age of patients at surgery was 20 years (Range 10–53 years) with a minimum follow up of 6 months or till patient was deceased earlier. Six patients had primary osteosarcoma, 4 had Ewing’s sarcoma, 2 had Spindle cell sarcoma while 1 had Giant cell tumour. Six patients underwent surgery with curative intent. No major per operative complication was encountered in any of the cases with a mean blood loss of 350 ml and mean duration of surgery being 75 minutes. At last, follow up only 6 patients were alive, with 2 patients alive with disease (Metastasis) and undergoing palliative treatment. None of our patients had local recurrence. Mean survivorship for the whole cohort was 9.2 months (Range 3-18 months) with a mean survivorship for the deceased group was 7.1 months (Range 3–16 months) and mean survivorship for alive patients was 11.6 months (range 9–18 months). All the alive patients had phantom limb sensations and only one had a prosthesis in place only for cosmetic reasons, at last follow up. Conclusion: Although FQA is a significantly body disfiguring procedure, but in large tumours of shoulder girdle, this is a viable option for local control of the disease. Based on our study, although relatively small sample size, we propose the combined anteroposterior approach to be safe and reliable for advanced shoulder girdle tumours.

References

Lehnhardt M, Hirche C, Daigeler A, Goertz O, Ring A, Hirsch T, et al. Soft tissue sarcoma of the upper extremities. Analysis of factors relevant for prognosis in 160 patients. Chirurg 2012;83(2):143–52.

Bhagia SM, Elek EM, Grimer RJ, Carter SR, Tillman RM. Forequarter amputation for high-grade malignant tumours of the shoulder girdle. J Bone Joint Surg Br 1997;79(6):924–6.

Goodman MD, McIntyre B, Shaughnessy EA, Lowry AM, Ahmad SA. Forequarter amputation for recurrent breast cancer: a case report and review of the literature. J Surg Oncol 2005;92(2):134–41.

Ham SJ, Hoekstra HJ, Schraffordt 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(6):543–8.

Holleb AI, Lucas JC. Palliative interscapulothoracic amputation in the management of the breast cancer patient. Cancer 1959;12(4):643–7.

Fanous N, Didolkar MS, Holyoke ED, Elias EG. Evaluation of forequarter amputation in malignant diseases. Surg Gynecol Obstet 1976;142(3):381–4.

Sim FH, Pritchard DJ, Ivins JC. Forequarter amputation. Orthop Clin N Am 1977;8(4):921–31.

Tsuda Y, Fujiwara T, Evans S, Kaneuchi Y, Abudu A. Extra-articular resection of shoulder joint for bone sarcomas: Oncologic and limb-salvage outcomes of 32 cases compared with shoulder disarticulation and forequarter amputation. J Surg Oncol 2020;121(4):612–9.

Qadir R, Sidhu S, Romine L, Meyer M, Duncan SF. Interscapulothoracic (forequarter) amputation for malignant tumors involving the upper extremity: surgical technique and case series. J Shoulder Elbow Surg 2014;23(6):e127–33.

Keevil JJ. Ralph Cuming and the interscapulothoracic amputation in 1808. J Bone Joint Surg Br 1949;31B(4):589– 95.

Crosby A. The first operation on record for removal of the entire arm, scapula, and three-fourths of the clavicle. 1875.

Tooms RE: Amputations of Upper Extremity. In Canale ST (ed). Campbell’s Operative Orthopaedics. 9 ed. St Louis, Mosby: 1998; p.550–60.

Ferrario T, Palmer P, Karakousis CP. Technique of forequarter (interscapulothoracic) amputation. Clin Orthop Relat Res 2004;423:191–5.

Karakousis CP. Principles of surgical resection for soft tissue sarcomas of the extremities. Surg Oncol Clin North Am 1993;2(4):547–75.

Hardin CA. Interscapulothoracic amputation for sarcomas of the upper extremity. Surgery 1961;49(3):355–8.

Puhaindran ME, Chou J, Forsberg JA, Athanasian EA. Major upper-limb amputations for malignant tumors. J Hand Surg Am 2012;37(6):1235–41.

Rickelt J, Hoekstra H, van Coevorden F, de Vreeze R, Verhoef C, van Geel AN. Forequarter amputation for malignancy. Br J Surg 2009;96:792–8.

Wittig JC, Bickels J, Kollender Y, Kellar-Graney KL, Meller I, Malawer MM. Palliative forequarter amputation for metastatic carci- noma to the shoulder girdle region: indications, preoperative evalua- tion, surgical technique, and results. J Surg Onc 2001;77:105–13.

Kumar A, Naranje S, Gupta H, Khan SA, Yadav CS, Rastogi S, et al. A single incision surgical new anterior technique for forequarter amputation. Arch Orthop Trauma Surg 2011;131(7):955–61.

Elsner U, Henrichs M, Gosheger G, Dieckmann R, Nottrott M, Hardes J, et al. Forequarter amputation: a safe rescue procedure in a curative and palliative setting in high-grade malignoma of the shoulder girdle. World J Surg Oncol 2016;14(1):216.

Faisham WI, Zulmi W, Nor MA, Rhendra MH. Forequarter amputation of the upper extremity for musculoskeletal tumors: posterior approach revisited. Med J Malaysia 2006;61(Suppl A):57–61.

Levine EA, Warso MA, McCoy DM, Das Gupta TK. Forequarter amputation for soft tissue tumours. Am Surg 1994;60(5):367–70.

Williard WC, Collin C, Casper ES, Hajdu SI, Brennan MF. The changing role of amputation for soft tissue sarcoma of the extremity in adults. Surg Gynecol Obstet 1992;175(5):389–96.

Subedi B, Grossberg GT. Phantom limb pain: mechanisms and treatment approaches. Pain Res Treat 2011;2011:864605.

Uustal H, Baerga E. Prosthetics. In: Physical medicine and rehabili- tation board review. New York: Demos Medical Publishing; 2004.

Yoak MB, Cocke WM Jr, Carey JP. Interscapulothoracic amputation. W V Med J 2001;97(3):148–50.

Silcox DH 3rd, Rooks MD, Vogel RR, Fleming LL. Myoelectric prostheses. A long-term follow-up and a study of the use of alternate prostheses. J Bone Joint Surg Am 1993;75(12):1781–9.

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Published

2021-12-31

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