Limb-Salvage Surgery of Soft Tissue Sarcoma with Sciatic Nerve Involvement

Area of Science:

• Oncology
• Surgical Oncology
• Orthopedic Oncology

Background:

• Soft tissue sarcomas (STS) with sciatic nerve involvement pose significant surgical and oncological challenges.
• Limb preservation is a key goal in current multimodal treatment strategies for these tumors.
• A need exists to evaluate outcomes and classify neural involvement for improved surgical planning.

Purpose of the Study:

• To evaluate the outcomes of limb-sparing surgery for STS involving the sciatic nerve.
• To propose a classification system for sciatic nerve involvement in STS.

Main Methods:

• Retrospective analysis of prospectively collected data from 27 patients with STS and sciatic nerve involvement (01/2010-01/2017).
• Preoperative classification of sciatic nerve involvement: Type A (encasement), Type B (contact), Type C (no involvement).
• Evaluation of clinical and oncological data, including disease progression and functional outcomes.

Main Results:

• Of 27 patients, 8 (Type A) had sciatic nerve resection, and 19 (Type B) had epineural dissection.
• Disease progression occurred in 29.6% of patients (11.1% local recurrence, 29.6% distant metastasis).
• Sciatic nerve resection extent significantly impacted leg function but not disease recurrence or survival.

Conclusions:

• The extent of sciatic nerve resection in carefully selected STS patients does not significantly affect recurrence or survival.
• A precise classification of neural involvement can guide the degree of nerve resection.
• This approach aims to optimize leg function preservation without compromising oncological results.