Secondary Amputation After Failed Limb-Salvage Surgery Shows Comparable Long-Term Oncological Outcomes to Primary Amputation in Extremity Sarcoma: A 5-Year Follow-Up Study

Aims: Extremity sarcomas (ES) are rare, aggressive malignancies requiring complex surgical decisions. While limb-salvage surgery (LSS) is the preferred treatment to preserve functionality, local disease progression can necessitate secondary amputation. The oncological outcomes of secondary amputation compared to primary amputation remain uncertain, particularly with long-term follow-up. This study aimed to compare overall survival (OS), metastasis-free survival (MFS), local recurrence-free survival (LRFS), and postoperative complications between ES patients undergoing primary amputation (V1) and those requiring secondary amputation after failing LSS (V2), with a minimum follow-up of five years. Methods: A retrospective review was conducted at a national sarcoma center, including 71 patients treated between 2007 and 2017. Patients were categorized into V1 (n = 28) and V2 (n = 43) groups. Clinical and oncological data were collected from medical records and imaging, including tumor stage, surgical margins, and postoperative complications. All patients were followed up for a minimum of five years or until death. Kaplan-Meier survival analysis was performed to evaluate OS, MFS, and LRFS. Results: OS was 25% in the V1 group and 39.5% in the V2 group (p = 0.6). MFS (10.5 months, p = 0.2) and LRFS (27.4 vs. 34.4 months, p = 0.6) were comparable between groups. Postoperative complications occurred in 34.9% (V1) and 32.1% (V2) of patients, with infections being the most common complication. Patients with complications exhibited shorter MFS (p = 0.029). Negative surgical margins were achieved at 96.4% (V1) and 97.6% (V2). Conclusions: Secondary amputation following failing LSS demonstrates similar oncological outcomes to primary amputation, even with a minimum follow-up of five years. These findings support LSS as the preferred initial approach for ES patients. Postoperative complications associated with reduced MFS underscore the need for rigorous postoperative protocols. A multidisciplinary approach remains essential for optimizing long-term outcomes.