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Evaluating limb salvage with sciatic nerve sacrifice: oncologic outcome, functional recovery, and patient
Sadegh Saberi1, Hamed Naghizadeh1, Alireza Talebi1
1Joint Reconstruction Research Center, Department of Orthopedic Surgery, Tehran University of Medical Sciences, Tehran, Iran.
Introduction:
To evaluate the oncologic and functional outcomes in a retrospective case series of 14 patients undergoing sciatic nerve resection as part of limb-sparing surgery for soft tissue sarcomas involving the gluteal region and posterior thigh.
Methods:
This retrospective study analyzed 14 patients treated between 2019 and 2022, each undergoing sciatic nerve resection to achieve oncologic margins. Tumor characteristics were reviewed, including histology, grade, size, and surgical margins. Functional outcomes were assessed using Musculoskeletal Tumor Society (MSTS) scores and additional metrics such as ambulation status, device dependence, and patient satisfaction.
Results:
The median tumor size was 12 cm, with nine high-grade tumors identified. An R0 margin was obtained in 93% (13/14) of patients. At a median follow-up of 40 months, local recurrence-free survival was 86% (12/14 patients). Five patients (36%) developed distant metastases; the overall survival rate at 3 years was 71% (10/14 patients). Functionally, 9 patients (64%) regained ambulatory function using orthotic devices, achieving a median MSTS score of 21/30 (70%, indicating moderate disability). Chronic neuropathic pain occurred in 43% (6/14) of patients, and 71% (10/14) experienced chronic leg edema. Nonetheless, all patients reported high satisfaction with limb preservation.
Conclusion:
Sciatic nerve resection during limb-sparing surgery provides effective local tumor control and allows for limb preservation despite notable functional impairment. Patient satisfaction remains high, supporting this approach as a potentially oncologically safe and acceptable alternative to amputation, which warrants further validation in larger studies.
Insights
Sciatic nerve resection in limb-sparing surgery for soft tissue sarcomas achieved excellent local tumor control and limb preservation. While functional deficits occurred, patient satisfaction remained high, offering an alternative to amputation.
Area of Science:
- Orthopedic Oncology
- Surgical Oncology
- Musculoskeletal Oncology
Background:
- Soft tissue sarcomas in the gluteal region and posterior thigh often involve critical neurovascular structures.
- Sciatic nerve involvement presents a surgical challenge, balancing oncologic control with functional preservation.
Purpose of the Study:
- To evaluate the oncologic and functional outcomes of sciatic nerve resection in limb-sparing surgery for soft tissue sarcomas.
- To assess the feasibility and impact of this procedure as an alternative to amputation.
Main Methods:
- Retrospective case series of 14 patients undergoing sciatic nerve resection between 2019 and 2022.
- Tumor characteristics (histology, grade, size, margins) and oncologic outcomes (recurrence, metastasis, survival) were reviewed.
- Functional outcomes were assessed using Musculoskeletal Tumor Society (MSTS) scores, ambulation status, device dependence, and patient satisfaction.
Main Results:
- Achieved R0 margin in 93% of patients with a median tumor size of 12 cm; 86% local recurrence-free survival at 40 months.
- Overall survival at 3 years was 71%. 64% regained ambulatory function with orthotics (median MSTS 70%).
- 43% experienced chronic neuropathic pain, 71% chronic leg edema, but all patients reported high satisfaction with limb preservation.
Conclusions:
- Sciatic nerve resection enables effective local tumor control and limb preservation in challenging sarcoma cases.
- Despite functional impairments, high patient satisfaction supports this approach as a viable alternative to amputation.
- Further validation in larger studies is warranted to confirm the oncologic safety and functional trade-offs.
