Limb-Salvage Surgery of Soft Tissue Sarcoma with Sciatic Nerve Involvement

Background. The surgical resection of soft tissue sarcomas (STS) with sciatic nerve involvement presents a significant surgical and oncological challenge. Current treatment strategies pursue a multimodal approach with the aim of limb preservation. We aim to evaluate the outcomes of limb-sparing surgery of STS in a patient cohort and to propose a classification for STS with sciatic nerve involvement. Methods. Patients receiving limb-preserving resections for STS with sciatic nerve involvement between 01/2010 and 01/2017 were included. Clinical and oncological data were prospectively collected in a computerized database and retrospectively analyzed. Sciatic nerve involvement in STS was classified preoperatively as follows: type A for nerve encasement; type B for nerve contact; and type C for no nerve involvement. Results. A total of 364 patients with STS were treated, of which 27 patients had STS with sciatic nerve involvement. Eight patients with type A tumors (29.6%) underwent sciatic nerve resection, and 19 patients with type B tumors (70.4%) received epineural dissections. Disease progression was observed in 8 patients (29.6%) with a local recurrence of 11.1% and distant metastasis in 29.6%. The type of nerve resection significantly influenced leg function but had no impact on disease recurrence or overall survival. Conclusion. In a cohort of carefully selected patients with STS and sciatic nerve involvement, the extent of sciatic nerve resection had no significant impact on disease recurrence or survival. Precise classification of neural involvement may therefore be useful in selecting the appropriate degree of nerve resection, without compromising oncological outcome or unnecessarily sacrificing leg function.

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Prognostic significance of lymph node metastasis and bone, major vessel, or nerve involvement in adults with high-grade soft tissue sarcomas

Cancer ◽

10.1002/1097-0142(19880901)62:5<999::aid-cncr2820620527>3.0.co;2-n ◽

1988 ◽

Vol 62 (5) ◽

pp. 999-1006 ◽

Cited By ~ 37

Author(s):

Wlodzimierz Ruka ◽

Lawrence J. Emrich ◽

Deborah L. Driscoll ◽

Constantine P. Karakousis

Keyword(s):

Lymph Node ◽

Soft Tissue ◽

Lymph Node Metastasis ◽

Prognostic Significance ◽

Soft Tissue Sarcomas ◽

High Grade ◽

Node Metastasis ◽

Nerve Involvement ◽

Major Vessel

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Soft Tissue Sarcoma – a Current Review of the Diagnostic and Treatment Strategies

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0820-6366 ◽

2019 ◽

Vol 157 (06) ◽

pp. 644-653 ◽

Cited By ~ 1

Author(s):

Sebastian Scheidt ◽

Cornelius Jacobs ◽

Sebastian Koob ◽

Kristian Welle ◽

Sebastian Walter ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Treatment Algorithm ◽

Treatment Strategies ◽

Soft Tissue Sarcomas ◽

Current Evidence ◽

Delayed Treatment ◽

Current Review ◽

Soft Tissue Swelling ◽

A Current

AbstractSoft tissue sarcomas are a heterogeneous group of neoplasias that due to their often clinically silent appearance often remain undetected or experience delayed treatment. Especially soft tissue swelling is often misinterpreted by patients and doctors and trivialized or verified with an incorrect biopsy technique. The hereby evoked complications for the patients are serious and may be reduced by simply following the available guidelines. The treatment of soft tissue sarcomas requires a close interdisciplinary coordination between specialists in tumor orthopedics, oncology, radiology, pathology and radiotherapy. On the basis of a selective literature review, the following article points out the current evidence on the treatment and illustrates a treatment algorithm.

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Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912014006010 ◽

2014 ◽

Vol 41 (6) ◽

pp. 440-444 ◽

Cited By ~ 4

Author(s):

Berliet Assad Gomes ◽

Max Rogério Freitas Ramos ◽

Rossano Kepler Alvim Fiorelli ◽

Camila Rodrigues de Almeida ◽

Stênio Karlos Alvim Fiorelli

Keyword(s):

Sciatic Nerve ◽

Hip Arthroscopy ◽

Average Distance ◽

Anatomical Variation ◽

Anatomical Study ◽

Access Point ◽

Type A ◽

Anatomical Variations ◽

Type B ◽

Surgical Access

Objective: To evaluate the anatomic topographic relation between the sciatic nerve in relation to the piriform muscle and the posterior portal for the establishment of hip arthroscopy.Methods: We dissected 40 hips of 20 corpses of adult Brazilians, 17 male and three female, six black, six brown and eight white. We studied the anatomical relationship between the sciatic nerve and the piriform muscle with their variations and the distance between the lateral edge of the sciatic nerve and the posterior portal used in hip arthroscopy. We then classified the anatomical alterations found in the path of the sciatic nerve on the piriform muscle.Results: Seventeen corpses had bilateral relationship between the sciatic nerve and the piriform muscle, i.e., type A. We found the following anatomical variations: 12.5% of variant type B; and an average distance between the sciatic nerve and the portal for arthroscopy of 2.98cm. One body had type B anatomical variation on the left hip and type A on the right.Conclusion: the making of the posterior arthroscopic portal to the hip joint must be done with careful marking of the trochanter massive; should there be difficult to find it, a small surgical access is recommended. The access point to the portal should not exceed two centimeters towards the posterior superior aspect of the greater trochanter, and must be made with the limb in internal rotation of 15 degrees.

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Effect of beta blocker use in soft tissue sarcomas.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e23571 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e23571-e23571

Author(s):

Edward De Leo ◽

Wissam Hanayneh ◽

Chintan Shah ◽

Yu Wang ◽

Ji-Hyun Lee ◽

...

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Beta Blocker ◽

Beta Blockers ◽

Treatment Strategies ◽

Soft Tissue Sarcomas ◽

Tumor Vascularity ◽

Tertiary Referral Center ◽

Stage 4 ◽

Significant Difference

e23571 Background: Soft tissue sarcomas (STS) are a rare, heterogenous group of cancers that tend to have a poor prognosis and few effective treatment strategies. Beta blockers (BB), in particular non-selective BB such as propranolol, have been shown to have an antitumor effect in different malignancies, including breast, colon, and angiosarcomas. The underlying mechanism is unclear but it is thought to be related to the inhibition of beta receptors on malignant cells, which leads to decrease in tumor vascularity and hematogenous spread. In this retrospective analysis, we examined the effect of BB on the outcomes of STS at a tertiary referral center. Methods: Adult patients from 2000 through 2019 with a diagnosis of STS with adequate follow up were included, and were divided into 2 groups: patients on BB at any point during treatment and/or up to 6 months prior to diagnosis, and patients without BB. The patient and tumor data were extracted and analyzed. The primary outcome was overall survival (OS). Statistical methods included descriptive analysis, univariable and multivariable Cox proportional hazard regression analyses and Kaplan-Meier survival plots. Results: 448 patient charts were analyzed. Median age at diagnosis was 55 (range 18-89). 54% were male. 4.9% of patients were diagnosed with stage 4 disease. Histologies included: undifferentiated pleomorphic sarcoma 26.1%, leiomyosarcoma 10%, synovial sarcoma 9.2%, liposarcoma 7.8%, osteosarcoma 2.7%, Ewing sarcoma 2% and others 42.2%. 18.1% of patients were on BB during treatment, with metoprolol the most commonly used (59%). 96% of patients on BB had HTN and 44% had coronary artery disease. Patients on BB were less likely to receive adjuvant therapy (18% vs 26%). Patients on BB were more likely to have stage 4 disease at presentation (9.9% vs 3.8%). Multivariate analysis showed there was no significant difference in overall survival between patients on BB and those not on BB, HR 1.3 (CI 0.8-2.1, p = 0.24). Conclusions: There is no difference in overall survival in patients on beta blockers during treatment for STS after controlling for stage, comorbidities, smoking, and age. Further studies are needed to evaluate the effect of specific beta blocker drugs on soft tissue sarcoma outcomes.

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Management of soft-tissue sarcomas; treatment strategies, staging, and outcomes

SICOT-J ◽

10.1051/sicotj/2017010 ◽

2017 ◽

Vol 3 ◽

pp. 20 ◽

Cited By ~ 4

Author(s):

Eyal M. Ramu ◽

Matthew T. Houdek ◽

Christian E. Isaac ◽

Colleen I. Dickie ◽

Peter C. Ferguson ◽

...

Keyword(s):

Soft Tissue ◽

Treatment Strategies ◽

Soft Tissue Sarcomas

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Limb Salvage Surgery without Radiation Therapy for Soft Tissue Sarcomas of the Foot

Foot & Ankle Surgery: Techniques, Reports & Cases ◽

10.1016/j.fastrc.2021.100096 ◽

2021 ◽

pp. 100096

Author(s):

Keiko Hayakawa ◽

Seiichi Matsumoto ◽

Keisuke Ae ◽

Taisuke Tanizawa ◽

Yuki Funauchi ◽

...

Keyword(s):

Radiation Therapy ◽

Soft Tissue ◽

Limb Salvage ◽

Salvage Surgery ◽

Soft Tissue Sarcomas ◽

Limb Salvage Surgery

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Free Functional Latissimus Dorsi Reconstruction of the Quadriceps and Hamstrings following Oncologic Resection of Soft Tissue Sarcomas of the Thigh

Sarcoma ◽

10.1155/2021/8480737 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Matthew T. Houdek ◽

Elizabeth P. Wellings ◽

Katherine E. Mallett ◽

Rachel L. Honig ◽

Peter S. Rose ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcomas ◽

Primary Treatment ◽

Limb Salvage Surgery ◽

Delayed Wound Healing ◽

Volumetric Muscle Loss ◽

High Incidence ◽

The Mean ◽

Muscle Groups ◽

And Function

Background. Limb-salvage surgery combined with radiotherapy has become the primary treatment for soft tissue sarcomas of the extremity. Free functional latissimus flaps (FFLF) are an option to restore function in the setting of volumetric muscle loss. The purpose of the current study was to examine the use of FFLF in patients undergoing resection of thigh sarcoma. Methods. Twelve patients with a sarcoma involving the hamstring (n = 6), quadriceps (n = 5), or combined (n = 1) defects which included multiple muscle groups were reviewed. This included 9 males and 3 females with a mean age and body mass index of 56 ± 12 years and 31.3 ± 5.7 kg/m2. Results. The mean defect volume and operative time was 3,689 ± 2,314 cm3 and 587 ± 73 minutes. Following reconstruction, the mean knee range of motion (ROM), MSTS93 score, and muscle strength was 89 ± 24°, 90 ± 15%, and 4 ± 1; with 75% of patients ambulating without gait aids. Seven (58%) patients sustained a complication, namely, delayed wound healing (n = 2). Conclusion. Although there was a high incidence of complications, FFLF can restore active knee ROM and function, with most patients ambulating without gait aids following reconstruction of large oncologic defects in the thigh.

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