Palliative forequarter amputation for metastatic carcinoma to the shoulder girdle region: Indications, preoperative evaluation, surgical technique, and results

James C. Wittig, Jacob Bickels, Yehuda Kollender, Kristen L. Kellar-Graney, Isaac Meller, Martin M. Malawer

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Objectives: Uncontrolled metastatic carcinoma of the shoulder girdle is a difficult oncologic problem. This study reviews our experience with palliative forequarter amputation with emphasis on patient selection criteria, preoperative radiologic assessment, surgical technique, epineural postoperative analgesia, and clinical outcome. Methods: Eight patients who underwent palliative forequarter amputation for metastatic carcinoma between 1980 and 1999 were analyzed retrospectively. Diagnoses included breast carcinoma (n=3), squamous cell carcinoma (n=2), hypernephroma (n=2), and carcinoma of unknown origin (n=1). All patients presented with severe, intractable pain and a useless extremity. Venography demonstrated obliteration of the axillary vein in each of the patients in whom this procedure was performed. Exploration of the brachial plexus confirmed tumor encasement and unresectability in all patients. Epineural catheters for bupivacaine infusion were placed for postoperative pain control. Results: All patients experienced dramatic pain relief and improved mobility and overall function. Life-threatening hemorrhage and sepsis were alleviated. There were no instances of phantom limb pain or adverse psychological reactions, and no complications related to epineural analgesia. Conclusions: Palliative forequarter amputation is relatively safe and reliable and provides effective pain relief for selected patients with unresectable metastatic carcinoma to the axilla and bony shoulder girdle in whom radiotherapy and/or chemotherapy has not been effective. The triad of pain, motor loss, and an obliterated axillary vein is indicative of brachial plexus infiltration and unresectability.

Original languageEnglish
Pages (from-to)105-113
Number of pages9
JournalJournal of Surgical Oncology
Volume77
Issue number2
DOIs
StatePublished - 2001
Externally publishedYes

Keywords

  • Axillary tumor(s)
  • Brachial plexus
  • Phantom limb pain
  • Regional analgesia
  • Unresectable tumor
  • Venography

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