Abstract
Background: Treatment for soft tissue sarcoma of the upper extremity has evolved to include limb salvage techniques. We reviewed our experience with limb salvage therapy for upper extremity sarcomas with an emphasis on functional outcomes following the reconstructive surgery.
Methods: A retrospective analysis was performed of 81 consecutive patients with soft tissue sarcoma of the upper extremity who had limb salvage therapy with reconstruction by a plastic surgeon. Univariate and multivariate regression analyses of relevant outcome variables were performed. Enneking functional scores were obtained from 43 patients.
Results: The study included 16 microvascular reconstructions and 67 non-microvascular reconstructions for a total of 83 reconstructions in 81 patients. The mean defect size was 129 cm2 (standard deviation: 106 cm2). The mean total functional score was 23.1 (range, 9 to 30). Any reconstruction-related complication and preoperative chemotherapy use were associated with a 7.3 point (P = .03) and 4.7 point (P = .01) decrease in total functional score, respectively. Kaplan-Meier product-limit analysis showed 82% 5-year overall survival and 67% 5-year disease-free survival rates.
Conclusions: For soft tissue sarcoma of the upper extremity, limb salvage with good functional outcome is possible with a judicious approach to reconstruction.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
American Cancer Society. What are the key statistics for sarcoma? http://www.cancer.org. Accessed March 12, 2003.
Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 1996; 14: 1679–89.
Brennan MF. The surgeon as a leader in cancer care: lessons learned from the study of soft tissue sarcomas. J Am Coll Surg 1996; 182: 520–9.
Lohman RF, Nabowi AS, Reece GP, Pollock RE, Evans GR. Soft tissue sarcoma of the upper extremity: a 5-year experience at two institutions emphasizing the role of soft tissue flap reconstruction. Cancer 2002; 94: 2256–64.
Kane JM 3rd, Gibbs JF, McGrath BE, Loree TR, Kraybill WG. Large, deep high-grade extremity sarcomas: when is a myocutaneous flap reconstruction necessary? Surg Oncol 1999; 8: 205–10.
Serletti JM, Carras AJ, O’Keefe RJ, Rosier RN. Functional outcome after soft-tissue reconstruction for limb salvage after sarcoma surgery. Plast Reconstr Surg 1998; 102: 1576–83.
Williard WC, Hajdu SI, Casper ES, Brennan MF. Comparison of amputation with limb-sparing operations for adult soft tissue sarcoma of the extremity. Ann Surg 1992; 215: 269–75.
Karakousis CP, Promakis C, Walsh DL. Primary soft tissue sarcoma of the extremities in adults. Br J Surg 1995; 82: 1208–12.
Bell RS, O’Sullivan B, Liu FF, et al. The surgical margin in soft tissue sarcomas. J Bone Joint Surg Am 1989; 71A: 370–5.
Sadoski C, Suit HD, Rosenberg A, Mankin H, Efird J. Pre-operative radiation, surgical margins and local control of soft tissue sarcomas. J Surg Oncol 1993; 52: 223–30.
Shiu MH, Castro EB, Hajdu SI, Fortner JG. Surgical treatment of 297 soft tissue sarcomas of the lower extremity. Ann Surg 1975; 182: 597–602.
Stojadinovic A, Jaques DP, Leung DH, Healey JH, Brennan MF. Amputation for recurrent soft tissue sarcoma of the extremity: indications and outcome. Ann Surg Oncol 2001; 8: 509–18.
Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop 1993; 286: 241–6.
Bray PW, Bell RS, Bowen CV, Davis A, O’Sullivan B. Limb salvage surgery and adjuvant radiotherapy for soft tissue sarcomas of the forearm and hand. J Hand Surg Am 1997; 22: 495–503.
Wiklund TA, Alvegard TA, Mouridsen HT, Rydholm A, Blomqvist CP. Marginal surgery and postoperative radiotherapy in soft tissue sarcomas. The Scandinavian Sarcoma Group experience. Eur J Cancer 1993; 29A: 306–9.
Pisters PW. Combined modality treatment of extremity soft tissue sarcomas. Ann Surg Oncol 1998; 5: 464–72.
Gustafson P, Arner M. Soft tissue sarcoma of the upper extremity: descriptive data and outcome in a population-based series of 108 adult patients. J Hand Surg Am 1999; 24: 668–74.
Wexler AM, Eilber FR, Miller TA. Therapeutic and functional results of limb salvage to treat sarcomas of the forearm and hand. J Hand Surg Am 1988; 13: 292–6.
Doi K, Kuwata N, Kawakami F, Hattori Y, Otsuka K, Ihara K. Limb-sparing surgery with reinnervated free-muscle transfer following radical excision of soft-tissue sarcoma in the extremity. Plast Reconstr Surg 1999; 104: 1679–87.
Stinson SF, DeLaney TF, Greenberg J, et al. Acute and long-term effects on limb function of combined modality limb sparing therapy for extremity soft tissue sarcoma. Int J Radiat Oncol Biol Phys 1991; 21: 1493–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, J.Y., Youssef, A., Subramanian, V. et al. Upper Extremity Reconstruction Following Resection of Soft Tissue Sarcomas: A Functional Outcomes Analysis. Ann Surg Oncol 11, 921–927 (2004). https://doi.org/10.1245/ASO.2004.06.026
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1245/ASO.2004.06.026