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

Abstract

Background The surgical resection of soft tissue sarcomas (STS) with sciatic nerve involvement presents a significant surgical and oncological challenge. Current treatment strategies pursue a multimodal approach with the aim of limb preservation. We aim to evaluate the outcomes of limb-sparing surgery of STS in a patient cohort and to propose a classification for STS with sciatic nerve involvement. Methods Patients receiving limb-preserving resections for STS with sciatic nerve involvement between 01/2010 and 01/2017 were included. Clinical and oncological data were prospectively collected in a computerized database and retrospectively analyzed. Sciatic nerve involvement in STS was classified preoperatively as follows: type A for nerve encasement; type B for nerve contact; and type C for no nerve involvement. Results A total of 364 patients with STS were treated, of which 27 patients had STS with sciatic nerve involvement. Eight patients with type A tumors (29.6%) underwent sciatic nerve resection, and 19 patients with type B tumors (70.4%) received epineural dissections. Disease progression was observed in 8 patients (29.6%) with a local recurrence of 11.1% and distant metastasis in 29.6%. The type of nerve resection significantly influenced leg function but had no impact on disease recurrence or overall survival. Conclusion In a cohort of carefully selected patients with STS and sciatic nerve involvement, the extent of sciatic nerve resection had no significant impact on disease recurrence or survival. Precise classification of neural involvement may therefore be useful in selecting the appropriate degree of nerve resection, without compromising oncological outcome or unnecessarily sacrificing leg function.

Anti-Tumor Effect and Neurotoxicity of Ethanol Adjuvant Therapy after Surgery of a Soft Tissue Sarcoma

“…In this study, our target was the thigh which is the most frequent location of STSs, being reported to account for approximately 38% of all STSs [ 19 ]. STSs arise in proximity to the sciatic nerve [ 34 , 35 ]. The sciatic nerve of the thigh has been preferentially selected for in vivo animal experiments [ 36 , 37 ].…”

Restoration of hamstring function following sciatic nerve resection at the greater sciatic foramen with reconstruction involving acellular nerve allograft and vascularized sural nerve autograft: A case report

“…Due to its importance in lower extremity motor and sensory function, sciatic nerve loss, especially when proximal, results in significant morbidity with the potential to progress to lower limb amputation. Historically, tumors that grossly involved the sciatic nerve were amputated (Sweiti et al, 2018). However, advances in reconstructive surgery have allowed for limb preservation despite extensive SN involvement.…”

Sciatic and Femoral Nerve Resection During Extended Radical Surgery for Advanced Pelvic Tumours

“…Extension to the sciatic notch remains a contraindication for surgery in most units. 5 Prompted by the high rates of limb salvage and mobility documented in the orthopedic literature after sciatic nerve resection for bone and soft tissue tumors, 6,7 some specialist centers have developed experience with en bloc sciatic nerve resection in the setting of pelvic exenteration for tumors extending to the sciatic notch. [8][9][10] These early reports indicate that limb function and mobility can be mostly preserved after pelvic exenteration with sciatic nerve resection in a small number of highly selected patients with specialist physiotherapy and orthotics input.…”