Epineural dissection is a safe technique that facilitates limb salvage surgery

Area of Science:

• Oncology
• Orthopedic Surgery
• Neurosurgery

Background:

• Epineural dissection is a surgical technique to preserve the sciatic nerve during soft tissue sarcoma resection.
• The safety and efficacy of epineural dissection regarding tumor recurrence and functional outcomes require evaluation.

Purpose of the Study:

• To determine if epineural dissection for sciatic nerve preservation during soft tissue sarcoma resection increases local or systemic tumor recurrence.
• To assess functional outcomes in patients undergoing epineural dissection compared to those with tumors distant from the nerve or requiring nerve resection.

Main Methods:

• Retrospective cohort study (Level II-2 evidence).
• Comparison of 43 patients undergoing epineural dissection with 44 patients with tumors distant from the nerve and 7 patients requiring nerve resection.
• Analysis of local and systemic recurrence rates and functional outcomes (Musculoskeletal Tumor Society scores, Toronto Extremity Salvage Scores).

Main Results:

• No significant difference in local or systemic recurrence rates between epineural dissection and tumors distant from the nerve.
• Equivalent functional outcomes between epineural dissection and tumors distant from the nerve.
• Patients undergoing nerve resection had worse Musculoskeletal Tumor Society scores but equivalent Toronto Extremity Salvage Scores compared to epineural dissection.

Conclusions:

• Epineural dissection is a safe and effective procedure for preserving the sciatic nerve in soft tissue sarcoma surgery.
• Nerve resection should be limited to cases where the sciatic nerve is completely encased by tumor.
• Epineural dissection, combined with radiotherapy, is a viable limb-sparing strategy.