The outcome comparison of limb salvage surgery versus amputation for high-grade osteosarcoma: A systematic review and meta-analysis of the last 7-year studies

Abstract

Introduction: Until now, the decision to choose between limb salvage surgery (LSS) and amputation for high-grade osteosarcoma has been controversial. Both techniques keep on progressing, thus necessitating updated analysis of each outcome. Materials and Methods: A systematic search was conducted to identify studies through PubMed, Google Scholar, and Cochrane database to identify relevant articles. A total of four studies (173 patients) from the year 2012 were included in the analysis and for the meta-analysis of the Musculoskeletal Tumor Society (MSTS) functional score, random effect model was used to pool the result. In each study, mean difference with a 95% confidence interval (CI) was calculated for continuous outcomes using review manager. Results: Four studies containing 173 patients were included in this study. Patients' characteristics, treatment methods, and outcome were compared for each treatment option. The mean MSTS score at final follow-up for LSS group (n = 112) was 80.2, as for amputation group (n = 61) was 59.3. There was a significant difference in terms of postoperative functional outcome using MSTS score between LSS and amputation (heterogeneity, I2 = 88%; weighted mean difference, 20.64; 95% CI: 9.86–31.43; P = 0.0002). The pooled data showed that the functional outcome, as shown by the MSTS score is better in the LSS group. Conclusion: The current meta-analysis suggests that LSS procedure is superior compared to amputation in terms of the functional outcome as measured by the MSTS score. Although the metastatic and 5-year survival rate is lower in LSS, adjuvant chemotherapy should be considered in certain patients, in order to maximalize recurrence and overall outcome.