FOREQUARTER AMPUTATION FOR HIGH-GRADE LIPOSARCOMA IN AN ELDERLY PATIENT: A CASE REPORT

Abstract

Background: Forequarter amputation (FQA) is a radical surgical procedure generally indicated for extensive malignant tumors of the shoulder girdle when limb-salvage is not feasible. In elderly patients, the perioperative management is challenging due to age-related physiological decline and comorbidities.

Case Presentation: We report the case of an 84-year-old woman with a large, high-grade liposarcoma involving multiple muscle groups of the right shoulder girdle. Imaging revealed tumor infiltration into intercostal, serratus anterior, pectoralis, subscapularis, latissimus dorsi, coracobrachialis, and short head of biceps brachii muscles. Given the extent of disease, a multidisciplinary team recommended a right FQA. General anesthesia was induced with propofol and atracurium, and maintained with isoflurane in a nitrous oxide-oxygen mixture. An arterial line was inserted for continuous blood pressure monitoring. Surgery involved en bloc resection of the right upper limb, scapula, and clavicle, with ligation of axillary vessels and brachial plexus division. Blood loss was approximately 800 mL, and 2 units of packed red cells were transfused. Postoperative analgesia included intravenous paracetamol and morphine. The patient recovered uneventfully and was discharged on postoperative day 7. Histopathology confirmed high-grade undifferentiated pleomorphic sarcoma.

Conclusion: This case highlights the feasibility of FQA in elderly patients when performed with careful multidisciplinary planning and vigilant perioperative management.