This meta-analysis examined outcomes of limb-salvage surgery (LSS) versus amputation for osteosarcoma. It found: 1) LSS had better functional outcomes than amputation. 2) The 5-year overall survival rate was higher for patients who received LSS than amputation. 3) There was no significant difference in local recurrence rates between LSS and amputation.

1. A meta-analysis of randomized control
trials of surgical methods with
osteosarcoma outcomes
Presenter
Dr Kundan
Department of Surgical oncology
Mahavir Cancer Sansthan , Patna

3. • Prior to neoadjuvant chemotherapy, amputations and
disarticulations were the dominant treatments for
osteosarcoma with a 5-year overall survival (OS) rate of only
about 20% .
• LSS has functional and physiological advantages over
traditional amputative procedures when combined with
neoadjuvant or adjuvant chemotherapy.
• Previous studies have shown that LSS is applicative for
localized osteosarcoma, while amputation is suitable for
aggressive malignant osteosarcoma
• It has been reported that the risk of local recurrence and the
5-year OS rate did not differ significantly between LSS and
amputation in osteosarcoma patients with pathological
fractures.

4. Literature search
• MEDLINE, Cochrane, EMBASE, and Google
Scholar databases were searched for relevant
data till April 30, 2016.
• Exclusion standard
LSS or amputation groups without a
comparison,
case series with less than 20 total patients,
letters, case reports, editorials, or reviews

7. outcome of measurement
• Local recurrence
• 5-year overall survival rate

9. There was no difference in the local recurrence rate between LSS and
amputation (OR = 0.87, 95% CI 0.62–1.37, P = 0.42).

12. Results
• LSS is better than amputation in functional
outcomes.
• 5- year overall survival rate of patients treated
with LSS was higher than those treated with
amputation.
• There was no difference in the local
recurrence rate between LSS and amputation

16. Results
• No statistical different of risk for developing relapse
between limb-salvage and amputation was found
relative risk (RR) =1.40, 95% confidence interval (CI):
0.71–2.79, (P = 0.33).
• The 5-year survival rate of patients underwent
limb-salvage surgery was smaller than patients
received amputation RR = 1.86, 95%CI: 1.19–2.89, (P =
0.01)
• The metastasis rate of patients underwent limb-salvage
surgery was significant decreased compared with
patients received amputation RR = 0.56, 95% CI: 0.34–
0.94, (P = 0.03).

21. • The overall incidence of local recurrence in LSS and
amputation group was 11.88% (57of480) and 7.73%(50 of
647), respectively. The results showed that there was no
significant differences between LSS and amputation group
(OR:1.03with95% CI 0.65-3.30; Z¼0.14, P¼0.89)
• The 5-year overall survival rate in LSS and amputation group
was 58.60% (252 of 430) and 49.84% (321 of 644),
respectively. In patients treated with LSS, the 5-year overall
survival rate was significantly higher than those treated with
amputation (OR:1.47 with 95% CI 1.10-1.97; Z¼2.61, Po0.05)
• The overall incidence of metastasis occurrence in LSS and
amputation group was 22.67% (17 of 75 ) and 44% (22 of 50),
respectively. Patients treated with LSS had a significantly
lower metastasis compared those with amputation (OR:0.24
with 95%CI 0.10- 0.60; Z¼3.05, Po0.05).
Results

22. Conclusion
• LSS can be safely used in localized
osteosarcoma patients with lower meta- static
occurrence and better survival, which won’t
increase the risk for local recurrence.