After the diagnosis of osteosarcoma, most patients should undergo chemotherapy first and then opt for surgery. However, there are a few patients who have advanced disease at the time of diagnosis, and the tumor size is relatively large and the load (i.e., the degree of danger of the tumor to the organism) is relatively high. The effect of chemotherapy at this time is not ideal. Because the chemotherapy effect of tumor is inversely proportional to the tumor load, that is to say, the larger the number of tumors and the higher the load, the worse the chemotherapy effect. It is very likely that chemotherapy does not achieve the purpose of tumor control, but delays the treatment because of chemotherapy. Therefore, for such patients, amputation surgery is considered to reduce the load first, followed by adjuvant chemotherapy.