Predictors of functional outcomes following limb salvage surgery for lower-extremity soft tissue sarcoma

• Published in: Journal of surgical oncology Vol. 73; no. 4; pp. 206 - 211
• Main Authors: Davis, A.M., Sennik, S., Griffin, A.M., Wunder, J.S., O'Sullivan, B., Catton, C.N., Bell, R.S.
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 01.04.2000; Wiley-Liss
• Subjects: Activities of Daily Living; Age Factors; Analysis of Variance; Biological and medical sciences; Disabled Persons - classification; Diseases of the osteoarticular system; Female; Follow-Up Studies; Forecasting; function; Health Status; Humans; Leg - innervation; Leg - physiology; Leg - surgery; limb preservation; Linear Models; Male; Medical sciences; Middle Aged; Motor Neurons - pathology; Multivariate Analysis; Muscle Contraction - physiology; Muscle, Skeletal - physiology; Orthopedic surgery; Osteotomy; outcome; Postoperative Complications; predictive factors; Prospective Studies; Radiotherapy, Adjuvant; Range of Motion, Articular - physiology; Sarcoma - surgery; Soft Tissue Neoplasms - surgery; soft tissue sarcoma; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Tumors of striated muscle and skeleton; Human; Postoperative; Prognosis; Sarcoma; Lower extremity; Malignant tumor; Quality of life; Conservative surgery; Health status; Limb; Decision aid; Soft tissue; Muscular tonus
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/(SICI)1096-9098(200004)73:4<206::AID-JSO4>3.0.CO;2-5

Background and Objectives Patient function has been conceptualized by clinical measures such as joint motion, muscle strength, disability, and general health status. The purpose of the current study was to evaluate tumor and treatment variables predictive of these conceptually different posttreatment functional outcomes in patients treated with limb preservation surgery for lower‐extremity soft tissue sarcoma. Methods One hundred seventy‐two patients with minimum 1‐year follow‐up were evaluated using the following outcomes: impairment, measured by the 1987 and 1993 versions of the Musculoskeletal Tumor Society Rating Scale (MSTS); disability, measured by the Toronto Extremity Salvage Score (TESS); and general health status, using the Short Form‐36 (SF‐36). Tumor and treatment‐related variables (age, gender, presenting disease status, anatomic site, tumor size, grade, depth, prior excision, irradiation, bone resection, motor nerve sacrifice, and complications) were extracted from the STS database. Results Large tumor size, bone resection, motor nerve resection, and complications were predictive of lower MSTS 1987 and 1993 scores. Patients with large, high‐grade tumors who required motor nerve resection were more disabled, as reflected by lower TESS scores. Only age and prior surgery were adverse predictors of SF‐36 score. Conclusions These results demonstrate that different factors are predictive of different patient outcomes, specifically, impairment, disability, and general health status. It is important to define function when counseling patients regarding their potential recovery based on tumor and treatment‐related variables. J. Surg. Oncol. 2000;73:206–211. © 2000 Wiley‐Liss, Inc.