Abstract
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.
Highlights
Soft tissue sarcomas (STS) are a rare and heterogeneous group of mesenchymal tumors, representing only 1% of all adult malignancies [1, 2]. e incidence in Europe has been reported as 4 per 100,000 people per year [3]. ese tumors vary in their tendency for aggressive behavior and can occur in all age groups and in a variety of anatomic sites [4]. e lower extremity, is the most commonly affected site with approximately 28% of all STS arising there [5]
A total of 364 patients with STS underwent surgical resection between January 1st, 2010 and January 31st, 2017. e lower extremity was affected in 179 patients (49.2%) and the upper extremity was affected in 19 patients (5.2%)
Our study has shown reasonable oncological and functional outcomes following limb-sparing surgery in a patient cohort with STS and sciatic nerve involvement treated in a specialized center. e frequency of local recurrence (11.1%) and distant metastasis (29.6%) compare well with a large prospective study of 1,041 patients with STS, which reported rates of 17% and 22%, respectively [21]
Summary
Soft tissue sarcomas (STS) are a rare and heterogeneous group of mesenchymal tumors, representing only 1% of all adult malignancies [1, 2]. e incidence in Europe has been reported as 4 per 100,000 people per year [3]. ese tumors vary in their tendency for aggressive behavior and can occur in all age groups and in a variety of anatomic sites [4]. e lower extremity, is the most commonly affected site with approximately 28% of all STS arising there [5]. Soft tissue sarcomas (STS) are a rare and heterogeneous group of mesenchymal tumors, representing only 1% of all adult malignancies [1, 2]. Ese tumors vary in their tendency for aggressive behavior and can occur in all age groups and in a variety of anatomic sites [4]. Local disease control is essential in the management of STS, with surgical resection being the only treatment modality capable of achieving complete tumor cell eradication [7]. Achieving negative microscopic margins upon resection of STS has been shown to significantly reduce the risk of local recurrence [8]. For STS with vascular involvement, reasonable oncological outcomes have been reported with vessel reconstruction in limbsalvage surgery [9,10,11]. Tumor infiltration of the sciatic nerve has previously been an Sarcoma
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