Ratnagiri Ranganath, Uppin Megha S, Uppin Shantveer G, Shantappa Rajshekar
Department of Surgical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India.
Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, India.
Indian J Surg Oncol. 2024 Mar;15(Suppl 1):132-136. doi: 10.1007/s13193-023-01810-z. Epub 2023 Aug 29.
Soft tissue sarcomas form 1% of all cancers and are rare. The lower limb is one of the commonest sites of sarcoma, with the thigh accounting for the majority of these tumors. Large tumors abut the neurovascular bundles both anteriorly and in the hamstring compartment. Nerve involvement, especially the major nerves such as the femoral and the sciatic, by these tumors, was considered to be an absolute contraindication for limb salvage procedures. We present our data of major nerve resection without amputation, in an attempt to demonstrate the possibility of equivalent functional and oncological outcomes in these rare tumors. A total of 86 cases of extremity soft tissue sarcomas were operated on during the period September 2019 to September 2022, of which there were 12 cases of major nerve resections of the lower extremity. These patients were followed up and their clinicopathological data collected and analyzed. The functional outcome was recorded at different intervals. Of the 12 patients who underwent nerve resection along with the tumor, only 1 patient developed a local recurrence. Two patients developed multiple lung metastases, and the other 9 patients are alive and free of disease, with a median follow-up of 26 months. The MSTS score was assessed at 1 month post-surgery, 3 months, 6 months, and 1 year post-surgery. Except for one patient where the score was 20%, all the other patients had scores of 80% or more. Major nerve involvement by soft tissue sarcomas is not an indication for amputation. Limb salvage can be performed with no effect on the oncological outcomes.
软组织肉瘤占所有癌症的1%，较为罕见。下肢是肉瘤最常见的发病部位之一，其中大部分肿瘤发生在大腿。大型肿瘤在前方和腘绳肌间隙均紧邻神经血管束。这些肿瘤累及神经，尤其是股神经和坐骨神经等主要神经，被认为是保肢手术的绝对禁忌证。我们展示了不进行截肢的主要神经切除的数据，试图证明在这些罕见肿瘤中实现同等功能和肿瘤学结果的可能性。2019年9月至2022年9月期间，共对86例肢体软组织肉瘤患者进行了手术，其中12例为下肢主要神经切除术。对这些患者进行了随访，并收集和分析了他们的临床病理数据。在不同时间点记录功能结果。在12例接受肿瘤切除并同时切除神经的患者中，只有1例出现局部复发。2例发生多发性肺转移，其他9例患者存活且无疾病，中位随访时间为26个月。在术后1个月、3个月、6个月和1年评估MSTS评分。除1例患者评分为20%外，其他所有患者的评分均为80%或更高。软组织肉瘤累及主要神经并非截肢的指征。可以进行保肢手术，且不影响肿瘤学结果。
