For many years, there were three options for owners of dogs with bone cancer, palliative care, amputation and amputation with chemotherapy, but lately there appears to be a fourth option: limb sparing surgery for dogs with bone cancer. Limb sparing surgery may provide an alternate choice for dogs who are not good candidates for amputation; however, even this surgery has some restrictions and potential for complications, which is why each dog should be evaluated on a case by case basis. Following is some information about limb sparing surgery for dogs with bone cancer.
A Painful Cancer
Among the variety of cancers that may affect dogs, bone cancer is one of the most painful. Dogs who are particularly stoic may attempt to mask the pain for some time, up until they no longer can. At which point dog owners assume their dog must have gotten achy overnight when in reality the dog has been suffering for quite some time.
Bone cancer in dogs destroys the bone, up to a point where, left untreated, the bone will shatter causing what's known in the medical field as a "pathological fracture." When this occurs, the only two options are amputation or surgery. It is best to treat the cancer before it gets to this point.
Leg amputation, along with chemo is therefore the recommended treatment. With no more leg, the pain is gone for a while and dogs get to enjoy a longer and better quality of life. The cancer will still be there, but it will give the dog some quality time with survival times ranging anywhere between 10 and 12 months.
However, what happens if the dog is not a good candidate for amputation? What if the dog is crippled with very severe arthritis or significant conditions like elbow dysplasia, hip dysplasia, cruciate rupture or perhaps some type of neurological condition which makes it difficult for the dog to bear weight on the remaining legs? What if the owner has a hard time putting the dog through amputation? This is where leg sparing surgery comes into place.
Saving the Leg
Also known as limb salvage surgery, as the name implies, leg sparing surgery entails saving the leg versus having the dog undergo amputation. So the dog gets to keep his, leg while the areas of diseased bone are removed.
The goal of limb sparing surgery in dogs is therefore to remove the parts of the diseased bone while saving the leg's functionality. What's used though to replace the diseased bone? In most cases, the bone is replaced with a bone graft taken by a donor dog and parts of healthy bone taken from the affected dog.
To increase the success rate of this surgery, it is used in combination with chemo and sometimes radiation therapy. Chemotherapy keeps any further spread of cancerous cells under check. Studies have shown the survival times of dogs undergoing bone-sparing surgery and chemo and dogs undergoing limb-sparing surgery and chemo are the same.
As mentioned though, not all dogs are good candidates for this type of surgery. Eligible dogs must have no fractures and less than 50 percent of the bone must be affected. Several tests must be performed such as blood work, x-rays and bone biopsy.
In most cases, the best results are attained from dogs with cancer affecting the radius and ulna bones. Results were not particularly rewarding in dogs affected by cancer of shoulder joint, ankle, knee or the tibia.
"Previous studies have shown that with adjunctive chemotherapy, no significant difference exists in survival rates between dogs undergoing amputation and dogs undergoing limb-sparing procedures."~DVM360
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Did you know? Another option to treat bone cancer in dogs that spares the dog's leg is CyberKnife RadioSurgery, also known as stereotacticradiosurgery. This form of treatment uses highly-concentrated radiation to remove cancerous tumors without cutting through the skin. According to Integrative Veterinary Care, dogs who weren't amputation candidates and were treated with radiosurgery had median survival times ranging between 255 days to 572 days. Much better than the one-year survival time using amputation and chemotherapy!
At the Vet's Office
Dogs who are candidates for limb sparing surgery must use a specialty hospital (like a a big university referral hospital) that does this type of procedure since it's not carried out by most vets.
There are several types of limb sparing surgery in dogs which include frozen cortical bone allograft implantation, pasteurized tumoral autografting, bone transport osteogenesis, and endoprosthesis. Consulting with a veterinary surgeon is the best option to find out what's the best option for the individual dog.
A big plus of using a referral hospital for the procedure is the fact of having an experienced surgeon performing the procedure and having the dog receive great aftercare. After the surgery, dogs will have to stay overnight and for a few days until the vet deems the dog is stable and comfortable enough to go home.
While limb sparing surgery is appealing, as mentioned, it is not free of complications. Complications of limb sparing surgery in dogs includes bone infection, implant failure and recurrence of tumors and fractures. Of course, most of these complications would not be seen if the dog was to undergo a traditional amputation.
As seen, recovery from a limb-sparing surgery is not without risks or complications. According to Dr. Bernard Séguin, a board-certified veterinarian specializing is surgery, infections are seen in up to 70 percent of cases with local recurrence and implant problems is seen in as many as 60 percent of the limbs. However, interestingly, dogs who got infections following the limb-sparing surgery had a better outcome and were blessed with longer survival times, as seen quoted below.
"Interestingly, dogs who develop infections are more likely to have overall successful surgeries and live longer, likely because the immune system’s response is strengthened by fighting the bacterial infection."~Dr. Susan Ettinger
Cost of Dog Limb Salvage Surgery
Unfortunately, on top of risks and complications, one added thing to factor in when considering limb salvage is cost. The costs indeed for dog limb sparing surgery can be almost prohibitive for those dog owners who do not have pet insurance.
According to veterinarian Dr. Stephen J. Withdrow,the cost for the surgery alone can range between $4,000 and 5, 000. Not to mention the additional costs for chemotherapy. For a 30 pound dog, cisplatin may cost $400, carboplatin $1,000, and doxorubicin $200.
Generally, it's always a good to call around for estimates on various vet services, but this might not be possible considering that this surgery is not carried out by the average veterinary hospital.
- Onkolink: Limb Sparing in Dogs
- DVM360: Surgery STAT: Limb sparing procedure is another option for dogs4
- DVM360: Surgery STAT: Limb sparing: less common procedures
- Vet Surgery Central: Limb-spare surgery for bone cancer.
- Straw RC, Withrow SJ. Limb-sparing surgery versus amputation for dogs with bone tumors. Vet Clin North Am: Small Anim Pract 1996;26:135-143.