Complete femoral nerve resection with soft tissue sarcoma: functional outcomes

Area of Science:

• Orthopedic Oncology
• Neurosurgery
• Reconstructive Surgery

Background:

• Femoral nerve resection's functional impact in soft tissue sarcoma management is poorly understood.
• Historically, sciatic nerve involvement often led to amputation, but resection is now common in limb-sparing surgery.
• This study compares functional outcomes of femoral versus sciatic nerve resection in sarcoma patients.

Purpose of the Study:

• To compare functional outcomes after femoral nerve resection versus sciatic nerve resection in soft tissue sarcoma patients.
• To evaluate functional outcomes in patients undergoing femoral nerve resection against those with sciatic nerve resection and a control group without nerve involvement.
• To inform patient counseling regarding the risks associated with femoral nerve resection.

Main Methods:

• Retrospective review of a prospectively collected database from a tertiary sarcoma referral center.
• Identification of patients who underwent femoral nerve resection during wide excision of soft tissue sarcoma.
• Collected data included demographics, treatment, complications, and functional scores (MSTS 1987, MSTS 1993, TESS); control groups included sciatic nerve resection and no nerve resection.

Main Results:

• Ten patients (all women, aged 47-78) with femoral nerve resections for soft tissue sarcomas were analyzed.
• Six patients experienced fractures post-surgery, often due to falls from absent knee extensors.
• No significant differences in functional scores (MSTS, TESS) were found between femoral and sciatic nerve resection groups (P = 1.0).

Conclusions:

• Femoral nerve resection carries higher morbidity than previously anticipated.
• Patients are at ongoing risk for fractures and injuries due to falls, even years after surgery.
• Counseling should address the specific functional deficits and long-term risks of femoral nerve resection in sarcoma management.