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Fukushima T, Okita Y, Watanabe N, Yokota S, Nakano J, Kawai A. Evaluation of clinical factors associated with early postoperative physical function and lower extremity functional impairment in patients with soft tissue sarcoma. Disabil Rehabil 2023:1-6. [PMID: 37622737 DOI: 10.1080/09638288.2023.2249413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/21/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE This study aimed to investigate the relationship between various clinical factors and physical function in the early postoperative period in patients with soft tissue sarcomas (STSs) by subjective and objective evaluations. MATERIALS AND METHODS The 90 patients enrolled in this study were classified into five groups according to tumor location: retroperitoneal, gluteal, groin, thigh, and lower leg. The Musculoskeletal Tumor Society (MSTS) score was evaluated at discharge; the timed up-and-go test (TUGT) was performed preoperatively and at discharge. Group comparisons by tumor location were performed. To identify significant factors associated with physical dysfunction, multivariate analysis was performed using an MSTS score of <80% and a change in pre and postoperative TUGT score. RESULTS There were no significant differences between the tumor location and physical function. The change in pre- and postoperative TUGT scores was significantly associated with an MSTS score of <80%. Quadriceps and tibialis anterior muscle resections were significantly associated with the change in pre- and post-operative TUGT scores. CONCLUSIONS The quadriceps and tibialis anterior muscles may affect physical dysfunction after surgery for STSs. Early postoperative rehabilitation should include the identification of resected muscles and functional improvement of residual muscles, possibly with orthotic support for knee extension and ankle dorsiflexion.
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Affiliation(s)
- Takuya Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Yusuke Okita
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Watanabe
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Shota Yokota
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
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Wu SA, deVries JA, Plantz MA, Dumanian G, Attar S, Ko JH, Peabody TD. Immediate Plastic Surgery Intervention after Soft Tissue Sarcoma Resection: Examining Wound Healing, Readmission, and Reoperation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4988. [PMID: 37305195 PMCID: PMC10256372 DOI: 10.1097/gox.0000000000004988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/16/2023] [Indexed: 06/13/2023]
Abstract
Many orthopedic and surgical oncologists use a multidisciplinary approach to soft tissue sarcoma (STS) resection. This study assesses the role of immediate plastic surgeon involvement during index soft tissue sarcoma resection. Methods Adult patients who underwent index STS resection between 2005 and 2018 were queried from an institutional database. Main outcomes analyzed were 90-day same-site reoperation, any-cause readmission, and wound healing complications. Univariate and multivariate logistic regression were used to identify risk factors. Additional evaluation was then performed for the following two cohorts: patients with and without plastic surgeon involvement. Results In total, 228 cases were analyzed. Multivariate regression demonstrated the following predictors for 90-day wound-healing complications: plastic surgery intervention [OR = 0.321 (0.141-0.728), P = 0.007], operative time [OR = 1.003 (1.000-1.006), P = 0.039], and hospital length of stay [OR = 1.195 (1.004-1.367), P = 0.010]. For 90-day readmission, operative time [OR = 1.004 (1.001-1.007), P = 0.023] and tumor stage [OR = 1.966 (1.140-3.389), P = 0.015] emerged as multivariate predictors. Patients whose resection included a plastic surgeon experienced similar primary outcomes despite these patients having expectedly longer operative times (220 ± 182 versus 108 ± 67 minutes, P < 0.001) and hospital length of stay (3.99 ± 3.69 versus 1.36 ± 1.97 days, P < 0.001). Conclusions Plastic surgeon involvement emerged as a significant protector against 90-day wound healing complications. Cases that included plastic surgeons achieved similar complication rates in all categories relative to cases without plastic surgery intervention, despite greater operative time, hospital length of stay, and medical complications.
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Affiliation(s)
- Scott A. Wu
- From the Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - John A. deVries
- Department of Orthopaedic Surgery, University of Nevada Las Vegas, Las Vegas, Nev
| | - Mark A. Plantz
- From the Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Gregory Dumanian
- Department of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Samer Attar
- Department of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jason H. Ko
- Department of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Terrance D. Peabody
- From the Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Gonzato O, Schuster K. The role of patient advocates and sarcoma community initiatives in musculoskeletal oncology. Moving towards Evidence-Based Advocacy to empower Evidence-Based Medicine. J Cancer Policy 2023; 36:100413. [PMID: 36806641 DOI: 10.1016/j.jcpo.2023.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Musculoskeletal sarcomas are rare cancers that as the whole family of sarcomas pose several challenges at different levels, ranging from medical knowledge to clinical research and policymaking. Addressing these challenges, necessarily calls for the inclusion of patient perspective inside the decision-making processes of every area that contributes to treatment improvement, from the provision of high-quality services by healthcare organisations to research issues. Without patient-provided inputs to inform decisions, the current paradigm of patient-centred care makes no sense and sounds at the least irrational if not unethical. Putting PROMs on "centre stage" in cancer research and care, could allow to build a truly Evidence Based Advocacy (EBA) and therefore to empower Evidence Based Medicine (EBM).
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Affiliation(s)
- Ornella Gonzato
- Fondazione Paola Gonzato-Rete Sarcoma ETS, Italy; Sarcoma Patient Advocacy Global Network (SPAGN), Germany.
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Westlake B, Pipitone O, Tedesco NS. Time to Functional Outcome Optimization After Musculoskeletal Tumor Resection. Cureus 2022; 14:e27317. [PMID: 36043020 PMCID: PMC9411075 DOI: 10.7759/cureus.27317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background There is ample literature describing surgical outcomes after oncologic musculoskeletal tumor surgery, however, there is limited understanding of the time to optimization of functional outcome scores after resection. The purpose of this study was to identify the time to functional outcome optimization of Musculoskeletal Tumor Society (MSTS) scores after surgery for bone and soft tissue tumors and to identify factors correlated with recovery. Methods We retrospectively reviewed 187 patients from April 2016 to May 2021 that had undergone surgical treatment for musculoskeletal tumors. We assessed MSTS scores to determine the time to optimization and evaluated patient-specific and surgical factors for any influence on post-operative recovery. Results The majority of patients (92%) achieved their optimized score in one year or less. Eighty-two percent achieved the maximum MSTS score of 30. Osseous tumors, malignancy, adjuvant treatment with radiation and/or chemotherapy, deep location for soft tissue tumors, and bony work required for soft tissue tumors all significantly impacted time to MSTS score optimization. Conclusion The majority of patients with musculoskeletal tumors undergoing surgery can be expected to improve up to one year postoperatively. Those with bone tumors, malignant tumors, treatment with radiation and/or chemotherapy, deep soft tissue tumors, and bony work for soft tissue tumors can expect to have a longer recovery time and are at higher risk for not achieving premorbid functionality.
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Stiles ZE, Lohman RF, Mann GN. Plastic Surgery Reconstruction of Sarcoma Resection Defects. Surg Clin North Am 2022; 102:583-599. [DOI: 10.1016/j.suc.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Morri M, Bekkering PW, Cotti M, Meneghini M, Venturini E, Longhi A, Mariani E, Forni C. Cross-Cultural Validation of the Italian Version of the Bt-DUX: A Subjective Measure of Health-Related Quality of Life in Patients Who Underwent Surgery for Lower Extremity Malignant Bone Tumour. Cancers (Basel) 2020; 12:cancers12082015. [PMID: 32717924 PMCID: PMC7465526 DOI: 10.3390/cancers12082015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 12/17/2022] Open
Abstract
The purpose of this study was to translate the English bone tumour DUX (Bt-DUX-Eng) questionnaire for lower extremity bone tumour patients, a disease-specific quality of life (QoL) instrument, into Italian and then examine the validity of the Italian version of Bt-DUX (Bt-DUX-It). The adaptation and translation process included forward translation, back-translation, and a review of the back-translation by an expert committee. The Bt-DUX-It was validated in a sample of adolescents treated for lower extremity osteosarcoma in Italy. Assessments included the Bt-DUX, the Toronto Extremity Salvage Score (TESS), and the European Organization for Research and Treatment Core Quality of Life Questionnaire of Cancer Patients (EORTC QLQ-C30). Fifty-one patients with a median age of 20 years (range: 15-25) completed the questionnaires. The mean Bt-DUX score was 70 (range: 16.30-100). The internal consistency of the overall score and that of the Bt-DUX-It was good: Cronbach's α was 0.95. Spearman's correlation coefficient between the Bt-DUX (total and domain scores) and EORTC QLQ C30 and TESS were overall moderate to good, reaching a p-value <0.01 in all cases. The Bt-DUX-It version is a useful tool for measuring QoL in patients with bone tumour and has similar internal consistency, construct validity, and discrimination as those of the Dutch and English versions.
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Affiliation(s)
- Mattia Morri
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.C.); (M.M.); (E.V.); (C.F.)
- Correspondence: ; Tel.: +39-051-6366354
| | - Peter Willem Bekkering
- Pediatric Physical Therapist & Postdoc researcher, Máxima sports & movement center, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
| | - Marco Cotti
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.C.); (M.M.); (E.V.); (C.F.)
| | - Matilde Meneghini
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.C.); (M.M.); (E.V.); (C.F.)
| | - Enrico Venturini
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.C.); (M.M.); (E.V.); (C.F.)
| | - Alessandra Longhi
- Department of Chemotherapy, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Elisabetta Mariani
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Cristiana Forni
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.C.); (M.M.); (E.V.); (C.F.)
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Xu Y, Xu G, Wu H, Lin F, Mao M, Baklaushev VP, Chekhonin VP, Peltzer K, Wang J, Wang G, Wang X, Zhang C. The Nomogram for Early Death in Patients with Bone and Soft Tissue Tumors. J Cancer 2020; 11:5359-5370. [PMID: 32742482 PMCID: PMC7391186 DOI: 10.7150/jca.46152] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/14/2020] [Indexed: 01/13/2023] Open
Abstract
Objectives: The present study aimed to evaluate the early mortality rate and associated factors for early death in bone and soft tissue tumors, and to construct predictive nomogram. Methods: Patients diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) dataset were enrolled. The early death (survival time ≤ 3 months) rate was calculated and associated risk factors were evaluated by the logistic regression models. The significant factors were used to construct predictive nomograms. Results: A total of 2,003 (8.5%) patients died within 3 months after cancer diagnosis, among whom 1,146 (4.9%) patients died from cancer-specific cause. Older age (19-50 and >50 years), grade (III and IV), reginal or distant stage were associated with higher odds of total, cancer-specific and non-cancer-specific early death. T2 stage, metastasis to brain and lung were risk factors for total and cancer-specific early death. Surgical interventions significantly decreased the odds of total, cancer-specific and non-cancer-specific early death. Female and black race were associated with lower odds of non-cancer-specific early death. The area under the curve (AUC) of the nomograms for total early death, cancer-specific and non-cancer-specific early death prediction was 88.0%, 89.0% and 83.2%, respectively. Conclusions: A total of 8.5% patients with bone and soft tissue tumors suffered early death. Several risk factors were associated with higher odds of early death while surgery can decrease the possibility of early death. Nomograms based on all related factors can be used to estimate the early death in bone and soft tissue tumors.
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Affiliation(s)
- Yao Xu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Guijun Xu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of orthopaedics, Tianjin Hospital, Tianjin, China
| | - Haixiao Wu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Feng Lin
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Min Mao
- Department of Pathology and Southwest Cancer Center, First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Vladimir P Baklaushev
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency of the Russian Federation, Moscow, Russian Federation
| | - Vladimir P Chekhonin
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
| | - Karl Peltzer
- Department of Research and Innovation, University of Limpopo, Turfloop, South Africa
| | - Jun Wang
- Department of Oncology, Radiology and Nuclear Medicine, Medical Institute of Peoples' Friendship University of Russia, Moscow, Russia
| | - Guowen Wang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Affiliation(s)
- Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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