Malignant Disease of the Extremities Treated by Exarticulation

Analysis of Two Hundred and Sixty-four Consecutive Cases with Survival Rates

¹ Section of Orthopaedic Surgery, Mayo Clinic and Mayo Foundation, Rochester

This analysis of major exarticulations performed for malignant disease of the extremities encountered at the Mayo Clinic indicates that the survival rates were adversely affected by the patients who received surgical treatment as a palliative measure. Conversely, some patients regarded as having a very dismal prognosis have had a surprisingly long postoperative survival. It can only be conjectured at the present time that the protracted survival of patients in whom cancer cells were known to have been left in the body at the time of operation may be attributable in part to the patient's own resistance to cancerous invasion.

Gordon-Taylor has suggested that a tumor may have the metabolic balance turned against it by some metabolic alteration of the parent organism and may cease growing for a variable time and even become smaller, only to assume its proliferative activity again at a later period. This seems a logical hypothesis.

Major exarticulation is now acceptable treatment for many types of malignant disease of the extremities. Except for palliative operations, forequarter amputation is now preferred by many to shoulder-joint disarticulation for the treatment of malignant disease of the upper part of the arm. In many cases, these procedures offer the patient the only existing chance of survival.

The five-year survival rates were respectively 40.6 per cent for forequarter amputation, 41.5 per cent for hindquarter amputation, 39.6 per cent for hip-joint disarticulation, and 19.2 per cent for shoulder-joint disarticulation. The survival rate for these operations as a combined group was 36.8 per cent.

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