The risk of postoperative complications and functional impairment after multimodality treatment for limb and trunk wall soft-tissue sarcoma: Long term results from a monocentric series

Abstract

Background and objectivesConservative surgery for soft-tissue sarcoma (STS) within multimodality treatment attempts to reconcile two contradictory requirements: assuring a good oncological outcome through a wide resection and preserving the function. The aim of our study is to verify whether our conservative approach to STS met these objectives. MethodsA retrospective database analysis was performed in adults with primary limb or trunk wall STS operated in a single center from 1989 to 2012. Predictive factors for postoperative complications and functional impairment were tested in a multivariate analysis. Results728 patients were operated (resection R0: 68%). Neoadjuvant chemotherapy (NAC) was given to 28%, postoperative radiotherapy to 70% of patients. Median follow-up was 103 months. At five years, overall survival was 80% and local recurrences 11%. Major postoperative complications occurred in 8% and functional impairment in 13% of the patients. Independent predictive factors for postoperative complications were American Society of Anesthesiologist classes 2 and 3 (OR: 2.3, CI: 1.2–4.5 and 4.0 CI: 1.7–9.3), tumor size >80 mm (OR: 2.5, CI: 1.3–4.9), tumor site (trunk wall/lower limb, OR: 4.1, CI: 1.3–13.6) and multifocal/multicompartmental spread (OR: 2, CI: 1.1–3.6). Independent predictive factors for function impairment were postoperative complications (OR: 5.3, CI: 2.8–10.1), NAC (OR: 3.6, CI: 2.2–5.8), and bone or neurovascular involvement (OR 3.3, CI 2.0–5.3), whereas Early Rehabilitation after Surgery (ERAS) improved outcome (OR: 0.5, CI: 0.3–0.9). ConclusionPostoperative complications induced functional impairment. They may be reduced by acting on comorbidity factors and careful tumor evaluation prior to surgery. Furthermore, ERAS measures improved function.