The risk of postoperative complications and functional impairment after multimodality treatment for limb and trunk wall soft-tissue sarcoma: Long term results from a monocentric series

Eur J Surg Oncol. 2017 Jun;43(6):1117-1125. doi: 10.1016/j.ejso.2017.01.018. Epub 2017 Feb 3.

Abstract

Background and objectives: Conservative surgery for soft-tissue sarcoma (STS) within multimodality treatment attempts to reconcile two contradictory requirements: assuring a good oncological outcome through a wide resection and preserving the function. The aim of our study is to verify whether our conservative approach to STS met these objectives.

Methods: A retrospective database analysis was performed in adults with primary limb or trunk wall STS operated in a single center from 1989 to 2012. Predictive factors for postoperative complications and functional impairment were tested in a multivariate analysis.

Results: 728 patients were operated (resection R0: 68%). Neoadjuvant chemotherapy (NAC) was given to 28%, postoperative radiotherapy to 70% of patients. Median follow-up was 103 months. At five years, overall survival was 80% and local recurrences 11%. Major postoperative complications occurred in 8% and functional impairment in 13% of the patients. Independent predictive factors for postoperative complications were American Society of Anesthesiologist classes 2 and 3 (OR: 2.3, CI: 1.2-4.5 and 4.0 CI: 1.7-9.3), tumor size >80 mm (OR: 2.5, CI: 1.3-4.9), tumor site (trunk wall/lower limb, OR: 4.1, CI: 1.3-13.6) and multifocal/multicompartmental spread (OR: 2, CI: 1.1-3.6). Independent predictive factors for function impairment were postoperative complications (OR: 5.3, CI: 2.8-10.1), NAC (OR: 3.6, CI: 2.2-5.8), and bone or neurovascular involvement (OR 3.3, CI 2.0-5.3), whereas Early Rehabilitation after Surgery (ERAS) improved outcome (OR: 0.5, CI: 0.3-0.9).

Conclusion: Postoperative complications induced functional impairment. They may be reduced by acting on comorbidity factors and careful tumor evaluation prior to surgery. Furthermore, ERAS measures improved function.

Keywords: Enhanced recovery after surgery; Functional outcome; Morbidity; Multimodal treatment; Soft-tissue sarcoma; Surgery.

MeSH terms

  • Abdominal Wall
  • Activities of Daily Living*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Chemotherapy, Cancer, Regional Perfusion / methods*
  • Combined Modality Therapy
  • Dacarbazine / therapeutic use
  • Doxorubicin / therapeutic use
  • Extremities / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Ifosfamide / therapeutic use
  • Male
  • Mesna / therapeutic use
  • Middle Aged
  • Multivariate Analysis
  • Neoadjuvant Therapy / methods
  • Postoperative Complications / epidemiology*
  • Radiotherapy, Adjuvant / methods*
  • Retrospective Studies
  • Risk Factors
  • Sarcoma / pathology
  • Sarcoma / therapy*
  • Soft Tissue Neoplasms / pathology
  • Soft Tissue Neoplasms / therapy*
  • Survival Rate
  • Thoracic Wall
  • Torso / surgery*
  • Tumor Burden
  • Young Adult

Substances

  • Dacarbazine
  • Doxorubicin
  • Mesna
  • Ifosfamide

Supplementary concepts

  • MAID protocol