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Tanaka A, Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Takazawa A, Komatsu Y, Ideta H, Ishida T, Takahashi J. Muscle strength and functional recovery for soft-tissue sarcoma of the thigh: a prospective study. Int J Clin Oncol 2023:10.1007/s10147-023-02348-4. [PMID: 37133781 DOI: 10.1007/s10147-023-02348-4] [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: 12/23/2022] [Accepted: 04/25/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND This study aimed to investigate changes in muscle strength and functional outcome before and after surgery for soft-tissue sarcoma of the thigh and to examine the timing of recovery. METHODS From 2014 to 2019, 15 patients who underwent multiple resections of the thigh muscle for soft-tissue sarcoma of the thigh were included in this study. The muscle strength was measured with an isokinetic dynamometer for the knee joint and with a hand-held dynamometer for the hip joint. The functional outcome assessment was based on the Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), European Quality of Life-5 Dimensions (EQ-5D), and maximum walking speed (MWS). All measurements were conducted preoperatively and at 3, 6, 12, 18, and 24 months postoperatively, and the ratio of postoperative to preoperative value was used. A repeated-measures analysis of variance was performed to compare changes over time and to investigate the recovery plateau. Correlations between changes in muscle strength and functional outcomes were also examined. RESULTS The muscle strength of the affected limb, MSTS score, TESS, EQ-5D, and MWS were significantly decreased at 3 months postoperatively. The recovery plateau was subsequently reached at 12 months postoperatively. The changes in muscle strength of the affected limb and functional outcome showed a significant correlation. CONCLUSIONS The estimated postoperative recovery for soft-tissue sarcoma of the thigh is 12 months after surgery.
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Affiliation(s)
- Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yasuo Yoshimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yukiko Komatsu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hirokazu Ideta
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takaaki Ishida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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2
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Novak R, Nevin JL, Rowell PD, Griffin A, Mazin S, Hofer SOP, O'Neill AC, Tsoi K, Ferguson PC, Wunder JS. A Size-Based Criteria for Flap Reconstruction After Thigh-Adductor, Soft-Tissue Sarcoma Resection. Ann Surg Oncol 2023; 30:3701-3711. [PMID: 36840861 DOI: 10.1245/s10434-023-13261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/01/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Resection of soft-tissue sarcomas from the adductor compartment is associated with significant complications. Free/pedicled flaps often are used for wound closure, but their effect on healing is unclear. We compared wound complications, oncologic, and functional outcomes for patients undergoing flap reconstruction or primary closure following resection of adductor sarcomas. METHODS A total of 177 patients underwent resection of an adductor sarcoma with primary closure (PrC) or free/pedicled flap reconstruction (FR). Patient, tumor, and treatment characteristics were compared, as well as wound complications, oncologic, and functional outcomes (TESS/MSTS87/MSTS93). To examine the relative benefit of flap reconstruction, number needed to treat (NNT) was calculated. RESULTS In total, 143 patients underwent PrC and 34 had FR, 68% of which were pedicled. There were few differences in demographic, tumor, or treatment characteristics. No significant difference was found in the rate of wound complications. Length of stay was significantly longer in FR (18 days vs. PrC 8 days; p < 0.01). Oncologic and functional outcomes were similar over 5 years follow-up. Uncomplicated wound healing occurred more often in FR compared with PrC for tumors with ≥15 cm (NNT = 8.4) or volumes ≥ 800 ml (NNT = 8.4). Tumors ≤ 336 ml do not benefit from a flap, whereas those > 600 ml are 1.5 times more likely to heal uneventfully after flap closure. CONCLUSIONS Although flap use prolonged hospitalization, it decreased wound healing complications for larger tumors, and in all sized tumors, it demonstrated similar functional and oncologic outcomes to primary closure. Our size-based treatment criteria can help to identify patients with large adductor sarcomas who could benefit from flap reconstruction. LEVEL OF EVIDENCE III (Retrospective cohort study).
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Affiliation(s)
- Rostislav Novak
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
| | - Jennifer L Nevin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Philip D Rowell
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Anthony Griffin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Sergey Mazin
- Department of Software Engineering, ORT Braude Academic College, Karmiel, Israel
| | - Stefan O P Hofer
- Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, University Health Network, Toronto, Canada
| | - Anne C O'Neill
- Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, University Health Network, Toronto, Canada
| | - Kim Tsoi
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, University Health Network, Toronto, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, University Health Network, Toronto, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, University Health Network, Toronto, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
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3
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Tanaka A, Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Takazawa A, Komatsu Y, Ishida T, Takahashi J. Influence of the adductor compartment resection on muscle strength and postoperative function in soft-tissue sarcoma of the thigh. Jpn J Clin Oncol 2021; 52:370-374. [PMID: 34969097 DOI: 10.1093/jjco/hyab207] [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: 08/09/2021] [Accepted: 12/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To predict the muscle strength and postoperative function for soft-tissue sarcoma arising from the adductor compartment of the thigh. METHODS Between 2003 and 2019, 17 cases that underwent resection of the adductor muscle group (adductor longus, adductor magnus, adductor brevis, gracilis and pectineus) for soft-tissue sarcoma in the adductor compartment of the thigh were included. The muscle strength was measured with an isokinetic dynamometer for the knee joint and with a hand-held dynamometer for the hip joint (ratio of affected to unaffected side). The Musculoskeletal Tumor Society score, Toronto Extremity Salvage Score, European Quality of Life-5 Dimensions and maximum walking speed were used to assess postoperative function and examine correlations with muscle strength. RESULTS In 13 cases that underwent an isolated resection of the adductor compartment, reduced adduction strength correlated with increased number of resected muscles in the adductor muscle group (P < 0.001). Postoperative function was maintained, showing no correlations with adduction strength. In four cases that underwent combined resections of other compartments, a decrease was observed in adduction strength as well as the muscle strength of other resected muscles, in addition to a decline in postoperative function. In the 4 or 5 adductor muscle resection group, the comparison between isolated and combined resection revealed comparable results for adduction strength but a significant decrease in postoperative function for the combined resection group. CONCLUSIONS Postoperative function can be preserved for isolated adductor compartment resection. Combined resections of multiple muscles in other compartments and most adductor muscles may result in decreased postoperative function.
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Affiliation(s)
- Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Yasuo Yoshimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Yukiko Komatsu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Takaaki Ishida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
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4
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Kask G, Repo JP, Tukiainen EJ, Blomqvist C, Barner-Rasmussen I. Soft Tissue Sarcoma of Lower Extremity: Functional Outcome and Quality of Life. Ann Surg Oncol 2021; 28:6892-6905. [PMID: 33740199 PMCID: PMC8460521 DOI: 10.1245/s10434-021-09774-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/24/2021] [Indexed: 02/06/2023]
Abstract
Background Few studies have focused on patient-related factors in analyzing long-term functional outcome and health-related quality of life (HRQoL) in patients with postoperative lower extremity soft tissue sarcoma (STS). Objective The purpose of this study was to investigate factors associated with postoperative functional outcome and HRQoL in patients with lower extremity STS. Methods This cross-sectional study was performed in a tertiary referral center using the Toronto Extremity Salvage Score (TESS), Quality-of-Life Questionnaire (QLQ)-C30 and 15 Dimension (15D) measures. Functional outcome and HRQoL data were collected prospectively. All patients were treated by a multidisciplinary team according to a written treatment protocol. Results A total of 141 patients who had undergone limb-salvage surgery were included. Depending on the outcome measure used, 19–51% of patients were completely asymptomatic and 13–14% of patients had an unimpaired HRQoL. The mean score for TESS, 15D mobility score, and QLQ-C30 Physical Functioning scale were 86, 0.83, and 75, respectively, while the mean score for 15D was 0.88, and 73 for QLQ-C30 QoL. Lower functional outcome was statistically significantly associated with higher age, higher body mass index (BMI), and the need for reconstructive surgery and radiotherapy, while lower HRQoL was statistically significantly associated with higher age, higher BMI, and reconstructive surgery. Conclusion Functional outcome and HRQoL were generally high in this cross-sectional study of patients with STS in the lower extremity. Both tumor- and treatment-related factors had an impact but patient-related factors such as age and BMI were the major determinants of both functional outcome and HRQoL. Supplementary Information The online version of this article (10.1245/s10434-021-09774-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gilber Kask
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland. .,Tampere University Hospital, Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere, Finland. .,Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Jussi P Repo
- Tampere University Hospital, Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere, Finland
| | - Erkki J Tukiainen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland
| | - Carl Blomqvist
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland.,Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Ian Barner-Rasmussen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland
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5
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Surgical Management of Lower Limb Sarcomas. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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6
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Nakamura T, Nakamura K, Hagi T, Asanuma K, Sudo A. Soft tissue sarcoma at the adductor compartment of the thigh may have a greater risk of tumor-associated events and wound complications. J Orthop Surg (Hong Kong) 2020; 27:2309499019840813. [PMID: 30955441 DOI: 10.1177/2309499019840813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Soft tissue sarcomas (STSs) of the thigh's adductor compartment frequently attain a large size before clinical presentation and displace the major neurovascular and lymph structures. We aimed to elucidate the clinical outcome in patients with STS of the thigh's adductor compartment. PATIENTS AND METHODS From March 1999 to June 2016, we treated 24 adult patients with primary STS of the thigh's adductor compartment. RESULTS The mean age at diagnosis was 60 years. There were 13 men and 11 women. The mean follow-up period after the date of the initial treatment was 84 months. The mean tumor size at diagnosis was 13.6 cm. The disease-specific survival was 75.3% at 5 years. Local recurrence was detected in seven patients. The 5-year local recurrence-free rate was 69.9%. The patients with proximal STS had significantly poorer local control, compared to the remaining patients. Twelve (50%) patients developed 14 surgical wound complications. Complications included wound dehiscence ( n = 7), infections ( n = 6), lymphorrhea ( n = 1), wound dehiscence and infection ( n = 1), and infection and lymphorrhea ( n = 1). Six patients underwent additional surgical treatment. Intraoperative blood loss and operative time were related to the incidence of wound complications. Intraoperative blood loss and operative time in patients with proximal adductor STS were significantly larger than those in the remaining patients. CONCLUSION We should take care of patients with STS of the thigh's adductor compartment, especially for proximal adductor STS, because they have a greater risk of local recurrence and wound complications.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Koichi Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Tomohito Hagi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
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7
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Elswick SM, Curiel DA, Wu P, Akhavan A, Molinar VE, Mohan AT, Sim FH, Martinez-Jorge J, Saint-Cyr M. Complications after thigh sarcoma resection. J Surg Oncol 2020; 121:945-951. [PMID: 32020627 DOI: 10.1002/jso.25830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/22/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Standard treatment for extremity sarcoma is limb-sparing surgery often with radiation, but complications occur frequently. We sought to determine factors predictive of wound complications after thigh sarcoma resection and reconstruction while analyzing trends over time. METHODS We reviewed all thigh defects requiring plastic surgeon reconstruction following sarcoma resection at our institution from 1997 to 2014. Patient demographics, comorbidities, operative characteristics, multi-modality therapies, and complications were analyzed. Wound complications were: infection, dehiscence, seroma, hematoma, or partial/total flap loss. RESULTS There were 159 thigh reconstructions followed for 30 months on average. Eighty-seven percent of patients underwent radiation and 42% had chemotherapy. Almost half (49.1%) had a complication. The most common wound complication was surgical site infection (23.3%) followed by dehiscence (19.5%), and seroma (10.7%). Less common were partial (2.5%) or total flap loss (0.6%). Reoperation was required in 21 patients (13.2%). Tobacco use, older patient age, cardiac disease, and higher body mass index were independently associated with wound complications. Complications trended towards decreasing over time, but this was not statistically significant. CONCLUSIONS Tobacco use, cardiac disease, and higher body mass index, but not the timing of reconstruction, appear to increase the risk of wound complications after thigh soft tissue sarcomas resection and plastic surgery reconstruction.
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Affiliation(s)
- Sarah M Elswick
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel A Curiel
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter Wu
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arya Akhavan
- Division of Plastic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
| | | | - Anita T Mohan
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Frank H Sim
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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8
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Kask G, Barner-Rasmussen I, Repo JP, Kjäldman M, Kilk K, Blomqvist C, Tukiainen EJ. Functional Outcome Measurement in Patients with Lower-Extremity Soft Tissue Sarcoma: A Systematic Literature Review. Ann Surg Oncol 2019; 26:4707-4722. [PMID: 31407171 PMCID: PMC6863783 DOI: 10.1245/s10434-019-07698-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 12/16/2022]
Abstract
Background The importance of functional outcome (FO) in the treatment of patients with extremity soft tissue sarcoma (STS) has been increasingly recognized in the last three decades. This systematic review aimed to investigate how FO is measured in surgically treated lower-extremity STS patients. Methods A systematic search of PubMed, Web of Science, and Scopus was performed based on the PRISMA guidelines. The methodologic quality of the publications was measured using the MINORS tool. The results from the included studies examining measurement types, measures, and time of FO measurement were compiled. The FO pooled mean and standard deviation were calculated as a weighted average for the groups. The validity of the applied measures is reported. Results The literature search found 3461 publications, 37 of which met the inclusion criteria. The measurement types used were clinician-reported outcomes (n = 27), patient-reported outcomes (n = 20), and observer-reported outcomes (n = 2). The most frequently used measures were the Toronto Extremity Salvage Score (TESS) (n = 16) and the Musculoskeletal Tumor Society (MSTS) score 1993 (n = 12). The postoperative FO was relatively good. The pooled mean TESS and MSTS 1993 scores were respectively 83.3 and 86.2 (out of 100). Of the 10 previously reported measures, 3 provide validated FO scores. The methodologic quality of publications was generally low. Conclusions Based on this systematic review, several different methods exist for assessing FO in patients with lower-extremity sarcoma. The most frequently used measure is a validated TESS. The postoperative FO of patients with lower-extremity STS seems to increase to the preoperative baseline level during long-term follow-up evaluation.
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Affiliation(s)
- Gilber Kask
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland. .,Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland.
| | - Ian Barner-Rasmussen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland
| | - Jussi Petteri Repo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Magnus Kjäldman
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland
| | - Kaarel Kilk
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland
| | - Carl Blomqvist
- Helsinki University Hospital Comprehensive Cancer Center, HUS, Helsinki, Finland
| | - Erkki Juhani Tukiainen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland
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Kito M, Ae K, Koyanagi H, Gokita T, Furuoka H, Okamoto M, Tanaka A, Suzuki S, Takazawa A, Aoki K, Yoshimura Y. Risk factor for wound complications following wide resection of soft tissue sarcoma in the adductor compartment of the thigh. Jpn J Clin Oncol 2019; 49:932-937. [DOI: 10.1093/jjco/hyz101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/03/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
The purpose of this study was to investigate deep-seated soft tissue sarcoma (STS) occurring in the adductor compartment of the thigh that underwent wide resection and to clarify the high-risk group for wound complications.
Patients and methods
From 2000 to 2017, we reviewed 104 cases of deep-seated STS occurring in the adductor compartment of the thigh that were treated at four specialized facilities with expertise in sarcoma treatment.
Results
Wound complications occurred in 40 cases (38.5%), of which 23 cases (22.1%) were cases with major wound complications (MWC). In univariate analysis, BMI (P < 0.01), maximum tumor diameter (P < 0.01), operation time (P < 0.01), amount of intraoperative bleeding (P < 0.01), and intraoperative intervention to the femoral artery and vein (P < 0.01) were significantly associated with wound complications. In multivariate analysis, the associated parameters were BMI (P < 0.01), maximum tumor diameter (P = 0.02), and intraoperative intervention to the femoral artery and vein (P = 0.01). When limited to cases with MWC, univariate analysis showed that maximum tumor diameter (P < 0.01), diabetes mellitus (P = 0.03), operation time (P < 0.01), amount of intraoperative bleeding (P < 0.01), and intraoperative intervention to the femoral artery and vein (P = 0.02) were significantly associated parameters. In multivariate analysis, maximum tumor diameter (P = 0.02) and amount of intraoperative bleeding (P = 0.04) were associated parameters.
Conclusions
For patients with risk factors for wound complications, control of bleeding are crucial when resecting deep-seated STS in the adductor compartment of the thigh. In cases with large tumors, surgeons should be especially cautious of cases requiring interventions that surround the femoral artery and vein in order to attain an appropriate surgical margin.
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Affiliation(s)
- Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
| | - Keisuke Ae
- Department of Orthopaedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - Hirotaka Koyanagi
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University
| | - Tabu Gokita
- Department of Orthopaedic Surgery, Saitama Cancer Center
| | - Hideto Furuoka
- Department of Orthopaedic Surgery, Saitama Cancer Center
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
| | - Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu Ueda Medical Center
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
| | - Yasuo Yoshimura
- Department of Orthopaedic Surgery, Shinshu Ueda Medical Center
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10
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Preoperative IMRT for soft-tissue sarcoma of the extremities and trunk: low rate of wound complications. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Kobayashi H, Iida T, Yamamoto T, Ikegami M, Shinoda Y, Tanaka S, Kawano H. Lymphaticovenous Anastomoses for Lymphedema Complicated by Severe Lymphorrhea Following Resection of Soft-Tissue Sarcomas of the Adductor Compartment: A Report of Two Cases. JBJS Case Connect 2017; 7:e80. [PMID: 29286964 DOI: 10.2106/jbjs.cc.17.00078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE Lymphedema and lymphorrhea are major causes of wound complications after the resection of soft-tissue sarcomas in the adductor compartment of the thigh. We report 2 cases of successful treatment of lymphedema and lymphorrhea, which had been refractory to nonoperative treatment, with use of lymphaticovenous anastomosis (LVA) and intraoperative indocyanine green lymphography after the resection of a sarcoma in the adductor compartment. CONCLUSION These 2 cases highlight that LVA can be a useful and minimally invasive alternative to myocutaneous flaps for the treatment of wound complications caused by lymphedema and lymphorrhea after surgery for soft-tissue sarcomas in the adductor compartment of the thigh.
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Affiliation(s)
- Hiroshi Kobayashi
- Departments of Orthopaedic Surgery (H.K., M.I., Y.S., and S.T.) and Plastic and Reconstructive Surgery (T.I. and T.Y.), Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takuya Iida
- Departments of Orthopaedic Surgery (H.K., M.I., Y.S., and S.T.) and Plastic and Reconstructive Surgery (T.I. and T.Y.), Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takumi Yamamoto
- Departments of Orthopaedic Surgery (H.K., M.I., Y.S., and S.T.) and Plastic and Reconstructive Surgery (T.I. and T.Y.), Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Masachika Ikegami
- Departments of Orthopaedic Surgery (H.K., M.I., Y.S., and S.T.) and Plastic and Reconstructive Surgery (T.I. and T.Y.), Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yusuke Shinoda
- Departments of Orthopaedic Surgery (H.K., M.I., Y.S., and S.T.) and Plastic and Reconstructive Surgery (T.I. and T.Y.), Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Departments of Orthopaedic Surgery (H.K., M.I., Y.S., and S.T.) and Plastic and Reconstructive Surgery (T.I. and T.Y.), Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Teikyo, Tokyo, Japan
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12
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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. Eur J Surg Oncol 2017; 43:1117-1125. [DOI: 10.1016/j.ejso.2017.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/15/2017] [Accepted: 01/24/2017] [Indexed: 01/27/2023] Open
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Ramu EM, Houdek MT, Isaac CE, Dickie CI, Ferguson PC, Wunder JS. Management of soft-tissue sarcomas; treatment strategies, staging, and outcomes. SICOT J 2017; 3:20. [PMID: 28287387 PMCID: PMC5347369 DOI: 10.1051/sicotj/2017010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022] Open
Abstract
Soft-tissue sarcomas (STS) are a rare group of malignant tumors which can affect any age group. For the majority of patients who present with a localized STS, treatment involves a multidisciplinary team decision-making approach ultimately relying on surgical resection with or without adjuvant radiation for successful limb salvage. The goals of treatment are to provide the patient with a functional extremity without local tumor relapse. The purpose of this article is to review the treatment of extremity STS, with a focus on staging, treatment options, and outcomes.
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Affiliation(s)
- Eyal M Ramu
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Matthew T Houdek
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Christian E Isaac
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Colleen I Dickie
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Peter C Ferguson
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Jay S Wunder
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
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Clinical features, treatment, and outcome in 102 adult and pediatric patients with localized high-grade synovial sarcoma. Sarcoma 2011; 2011:231789. [PMID: 21559258 PMCID: PMC3087894 DOI: 10.1155/2011/231789] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 02/01/2011] [Accepted: 02/15/2011] [Indexed: 01/27/2023] Open
Abstract
Background. There remains controversy on the routine use of chemotherapy in localized SS. Methods. The records of 87 adult (AP) and 15 pediatric (PP) patients with localized SS diagnosed between 1986 and 2007 at 2 centres in Toronto were reviewed. Results. Median age for AP and PP was 37.6 (range 15–76) and 14 (range 0.4–18) years, respectively. 65 (64%) patients had large tumours (>5 cm). All patients underwent en bloc surgical resection resulting in 94 (92.2%) negative and 8 (7.8%) microscopically positive surgical margins. 72 (82.8%) AP and 8 (53%) PP received radiotherapy. Chemotherapy was
administered to 12 (13.8%) AP and 13 (87%) PP. 10 AP and 5 PP were evaluable for response to
neoadjuvant chemotherapy, with response rate of 10% and 40%, respectively. 5-year EFS and OS was
69.3 ± 4.8% and 80.3 ± 4.3%, respectively, and was similar for AP and PP, In patients with tumors >5 cm, in whom chemotherapy might be considered most appropriate, relapse occurred in 9/19 (47%) with
chemotherapy, compared to 17/46 (37%) In those without. Conclusions. Patients with localized SS have a
good chance of cure with surgery and RT. Evidence for a well-defined role of chemotherapy to improve
survival In localized SS remains elusive.
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Kemp MA, Hinsley DE, Gwilym SE, Giele HP, Athanasou NA, Gibbons CL. Functional and oncological outcome following marginal excision of well-differentiated forearm liposarcoma with nerve involvement. J Hand Surg Am 2011; 36:94-100. [PMID: 21109363 DOI: 10.1016/j.jhsa.2010.09.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 09/21/2010] [Accepted: 09/24/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE Liposarcoma is one of the most common soft tissue sarcomas in adults. It is often low-grade and can occasionally involve neurovascular structures. We present the functional and oncological outcome resulting from planned marginal excision of a series of forearm low-grade liposarcomas with nerve involvement. METHODS The Oxford tumor registry was used to identify cases of histologically proven, well-differentiated liposarcoma of the forearm, with nerve involvement, treated surgically between 1997 and 2006. Nerve involvement was identified clinically with symptoms or signs of nerve compression, or by images showing direct contact of the tumor with a nerve on magnetic resonance imaging. This was then further defined at the time of surgery as tumor abutting (capsular involvement) or encasing a peripheral nerve. Demographic and clinical data were collected and oncological outcome was assessed by noting local and distant recurrence during follow-up. Postoperative functional outcome was assessed using the Toronto Extremity Salvage Scores. RESULTS Eight cases were identified, 6 with preoperative neurological symptoms. The total group comprised 6 men and 2 women with a mean age of 61 (range, 30-71) years. At surgery, all had their tumors successfully excised, with preservation of the involved nerves. In those with preoperative neurological symptoms, complete recovery occurred by 18 months after surgery. The average follow-up was 5 years (range, 3-9 y). There were no cases of either local or distant recurrence of disease, with a mean Toronto Extremity Salvage Score of 99%. CONCLUSIONS Planned marginal excision of a well-differentiated liposarcoma, arising in the forearm and involving nerve, can result in excellent functional and oncological outcome. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Mark A Kemp
- Nuffield Orthopaedic Centre, Oxford, United Kingdom.
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Rudiger HA, Ngan SYK, Choong PFM. Surgical outcome of soft tissue sarcomas of the adductor compartment. J Orthop Surg (Hong Kong) 2009; 17:284-7. [PMID: 20065364 DOI: 10.1177/230949900901700307] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To review outcomes and complications of 25 consecutive patients with soft tissue sarcomas in the adductor compartment. METHODS Records of 11 men and 14 women aged 20 to 83 (mean, 56) years who underwent resection for soft tissue sarcomas in the adductor compartment were reviewed. Two of the patients had undergone inadequate resection of the tumour elsewhere. No patient had metastases. 20 and 2 patients underwent neo-adjuvant and postoperative radiotherapy, respectively. The interval between radiotherapy and surgery was at least 3 weeks. No neo-adjuvant chemotherapy was given. 24 patients underwent limb salvage surgery and one had external hemipelvectomy. 21 patients had direct wound closure; in 4 a microsurgical free flap was used. RESULTS The overall survival rate was 81% and 72% at 3 and 5 years, respectively, and remained unchanged until the end of follow-up. Four patients died from pulmonary metastases and one died from liver metastases. One patient had local recurrence, and 7 (26%) developed major complications. Five patients underwent revision surgery. CONCLUSION Good survival and local control rates can be achieved in patients with soft tissue sarcomas in the adductor compartment using limb salvage and radiotherapy.
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Affiliation(s)
- Hannes A Rudiger
- Department of Orthpaedics, St Vincent's Hospital, Melbourne, Australia.
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Rimner A, Brennan MF, Zhang Z, Singer S, Alektiar KM. Influence of compartmental involvement on the patterns of morbidity in soft tissue sarcoma of the thigh. Cancer 2009; 115:149-57. [PMID: 19090010 DOI: 10.1002/cncr.23975] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The authors sought to determine whether differences existed in patterns of outcome and morbidity between the 3 thigh compartments after limb-sparing surgery and postoperative radiation therapy (RT). METHODS A total of 255 patients with primary soft tissue sarcoma (STS) of the thigh were identified in our sarcoma database (1982-2002). More than 80% of tumors were >5 cm, high grade, and deep; 33% had close or positive microscopic resection margins. Adjuvant RT consisted of brachytherapy alone (BRT; 63%), external beam RT alone (EBRT; 31%), or a combination of brachytherapy and EBRT (6%). There were 125 anterior, 58 medial, and 72 posterior lesions. The 3 compartments were balanced as to tumor grade, size, depth, margin status, and RT type. RESULTS Overall local control (LC) was 89%, distant metastases-free survival (DMFS) was 61%, and overall survival (OS) was 66% at 5 years (median follow-up, 71 months). Overall rates for complications at 5 years were wound reoperation (10%), edema (13%), joint stiffness (12%), nerve damage (8%), and bone fractures (7%). Wound reoperation and edema were significantly higher for medial-compartment tumors (P=.01 and .005, respectively), whereas nerve damage occurred more frequently in posterior-compartment tumors (P<.001). There were no differences among bone fracture, joint stiffness, DMFS, or OS rates between compartments. CONCLUSIONS Although tumor control was similar for all 3 compartments, more wound reoperation and edema were observed in the medial compartment, and more nerve damage was noted in the posterior compartment. These results may help guide decisions concerning current patients and improve the design of future treatments tailored to compartments.
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Affiliation(s)
- Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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