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What is limb salvage surgery?

Until a few decades ago, most extremity (limb) malignant tumors were treated with one surgery – Amputation. However, with the availability of chemotherapy, radiotherapy, good quality affordable tumor endoprosthesis (metallic devices to replace surgically removed tumor affected bones and joints), allografts (donated human bone from a tissue bank), advanced surgical techniques and a multi-disciplinary surgical team, amputation can be avoided in more than 80% of these patients, without compromising the overall cancer treatment. This kind of surgery where the malignant tumor is removed safely while preserving the patient’s limb, is known as Limb Salvage Surgery.

There are two main goals in Limb Salvage Surgery for any extremity malignant tumor:

1. To remove the disease effectively, ensuring the lowest possible chance of its recurrence (relapse).

2. To preserve as much of the normal tissues as is safely possible without compromising on the first goal, so as to be able to retain or restore as much normal function as possible.

It is very clear that these are two conflicting goals. By removing excessive amounts of normal tissue along with the diseased area, we may lower the risk of local recurrence of disease. However, removing more normal tissue than necessary will cause loss of function, which was due to that normal tissue; a situation which may be totally unnecessary and therefore, avoidable. On the other hand, by trying to preserve maximum amount of normal tissue while removing the disease, we risk leaving a few cells or small bits of disease tissue behind, thereby increasing the risk of local recurrence of the disease; a situation which is unacceptable and should be avoided at all costs.

Thus, clearly, Limb and Joint Preserving Surgery is about striking the right balance between these two conflicting goals, ensuring maximum preservation of function without compromising on disease control, i.e., in short, achieve as much of goal 2 as possible without affecting goal 1.

Limb and Joint Preserving Surgery follows well established rules and protocols generated through years of research in some of the leading cancer hospitals of the world. These rules are applied to every case and are interpreted by taking into consideration the huge number of different variables like, the diagnosis, location of the disease, age of the patient, stage of the disease, size of the disease, etc. (all of which make every case different, even if the diagnosis is the same). A treatment strategy which best suits the particular case is then planned and executed.