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All issues Volume 3 (2017) SICOT-J, 3 (2017) 20 Full HTML

Table 4.

Functional outcome following sarcoma resection.

Paper Patient population Comparison Outcome measure Impact on functional outcome
Davis et al. [58] Lower extremity STS Function of patients with limb salvage

  • MSTS 87

  • MSTS 93

  • TESS

  • SF-36

 Large tumor size:

  • Lower extremity MSTS 1987, MSTS 1993, TESS

Motor nerve resection (femoral, obturator, sciatic, peroneal, and posterior tibial nerves):

  • Lower MSTS 1987, MSTS 1993, TESS

Postoperative complications”

  • Lower MSTS 1987

High-grade tumors:

  • Lower MSTS 1993 and TESS

Bone resection:

  • Lower MSTS 1993
Davis et al. [32] Extremity STS Pre- vs. Postoperative radiotherapy

  • MSTS

  • TESS

  • SF-36

 Postoperative radiotherapy:

  • Improved MSTS, TESS, and SF-36 at 6 weeks postoperative only

SF-36 compared to normative data:

  • Lower for both treatment arms across all time points

Wound complications:

  • Lower MSTS at 6 weeks, 3, 6, 12, and 24 months

  • Increased disability compared to baseline TESS

Large tumor size (>10 cm):

  • Lower MSTS scores at 6, 12, and 24 months

Motor nerve resection:

  • Lower MSTS scores

Previous unplanned excision:

  • Lower TESS score at 3, 6, 12, and 24 months
Davis et al. [31] Extremity STS Late morbidity:

  • Pre- (50 Gy) vs. Postoperative (66 Gy) radiotherapy

  • MSTS

  • TESS

 Subcutaneous fibrosis:

  • Decreased MSTS and TESS

Joint stiffness:

  • Decreased MSTS and TESS

Extremity lymphedema:

  • Decreased MSTS and TESS

Pre- vs. Postoperative radiotherapy:

  • No difference in MSTS or TESS

  • Trend toward greater fibrosis with postoperative radiotherapy
Payne et al. [63] Upper extremity STS with flap coverage Pedicled vs. Free flap for wound coverage

  • MSTS 87

  • MSTS 93

  • TESS

 Pedicled vs. free flaps:

  • Decreased MSTS 87 from pre- to postoperative in patients with either pedicled or free flap

  • Decreased MSTS 93 for free flaps

  • No difference in TESS between groups

  • Patients rated their function better compared to the actual rated impairment
Davis et al. [66] Lower extremity limb salvage sarcoma patients Relationship of symptoms to function during 1st year postoperative

  • Stiffness

  • Fatigue

  • Pain

  • Weakness

  • Limited range of motion

  • TESS

 Stiffness:

  • Plateaus at 3 months

  • Remains constant over the year

Fatigue:

  • Plateaus at 3 months

  • Remains constant over the year

Pain:

  • Constant for 3 months then declines over study

Weakness:

  • Constant for 3 months then declines over study

  • Limited Range of Motion:

  • Constant decline over study

TESS:

  • Presence of pain, stiffness, weakness, and limited range of motion were predictors of worse outcome
Gerrand et al. [59] Lower Extremity Limb Salvage Sarcoma patients Sarcoma location and functional outcome:

  • Groin/Femoral triangle

  • Buttock

  • Anterior thigh

  • Medial thigh

  • Posterior thigh

  • Popliteal fossa

  • Posterior calf

  • Anterolateral leg

  • Foot and ankle

  • MSTS 93

  • TESS

 Deep vs. superficial:

  • Superficial tumors have improved MSTS and TESS scores

Superficial tumors:

  • No decrease in MSTS or TESS from to pre- to postoperative

Deep Tumors:

  • No difference in MSTS or TESS based on tumor location

Groin/Femoral triangle tumors:

  • Increased pain based on the MSTS compared to other anatomic areas

  • Decreased ability to sit, put on socks, getting in and out of bath, bending to pick up items

  • More likely to have a limp or gait handicap

Buttock/Posterior thigh:

  • Decreased ability to sit
Ghert et al. [46] Lower extremity limb salvage sarcoma patients Vascular reconstruction and functional outcome:

  • Femoral

  • Iliofemoral

  • Popliteal

  • Tibial/Peroneal

  • TESS

 Vascular reconstruction:

  • More likely to need a muscle flap, have a wound complication, sustain a deep vein thrombosis (DVT), suffer from edema of the limb, and require an amputation

  • No difference in the postoperative TESS
Jones et al. [45] Lower extremity limb salvage sarcoma patients Nerve resection and functional outcome:

  • Femoral

  • Sciatic

Comparison of femoral nerve resection and location:

  • Gender-matched large anterior thigh

  • All large anterior thigh

  • MSTS 87

  • MSTS 93

  • TESS

 Femoral nerve resection:

  • No difference in MSTS 87, MSTS 93, or TESS between patients with sciatic nerve resection, gender-matched large anterior thigh tumors, or all patients with large anterior thigh tumors

  • Long-term risk of falling which could lead to fracture
Pradhan et al. [67] Patients with STS of the adductor compartment Outcome of treatment of adductor compartment STS

  • TESS

 Impact on TESS:

  • Wound complications and high-grade tumors had lower TESS

  • Timing of radiotherapy (pre- vs. postoperative) had no effect on TESS

  • Need for a muscle flap; had no effect on TESS
Riad et al. [62] Patients with radiation induced STS Outcome of treatment in patients with a radiation-induced STS compared to patients with a sporadic STS

  • MSTS 87

  • TESS

 Radiation induced vs. Sporadic STS:

  • No difference in the MSTS 87 or TESS

MSTS 87 = Musculoskeletal Tumor Society Functional Rating System 1987, a measure of impairment; MSTS 93 = Musculoskeletal Tumor Society Functional Rating System 1993, a measure of impairment; TESS = Toronto Extremity Sarcoma Salvage Score, a measure of functional disability; SF-36 = 36-Item Short Form Health Survey, a quality of life measure.

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