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Resection of the sciatic, peroneal, or tibial nerves: Assessment of functional status

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Abstract

Background: Lower-extremity tumors are often treated by amputation rather than limbsparing excision that sacrifices the sciatic nerve or a branch. This study assessed the functional outcome of major nerve sacrifice during limb-sparing resections for lower-extremity soft tissue sarcoma.

Methods: Patients who underwent division of the sciatic, tibial, or personeal nerve(s) during limb-sparing sarcoma surgery (January 1982 through June 2000) were identified. Eleven surviving patients evaluated their pre- and postoperative functional status by self-administered questionnaire (six sciatic, two tibial, and three peroneal nerve divisions).

Results: Eighteen patients (10 male, 8 female; 14–84 years old) had nine primary and nine locally recurrent tumors. Tumors were high (16) or low grade (two). Five patients died of disease and two died of other causes. Median overall survival was 50 months. One of 11 reported increased pain. Eight had new phantom sensations with a median intensity of 4.5 (1=least; 10=most). All patients used an ankle brace to walk after a sciatic (four) or personeal (one) division. Walking ability and distance after surgery was unchanged (nine), improved (one), and worsened (one). Standing improved in 7 of 11 patients. Proprioception in the affected extremity was retained in six. The median postoperative leg functional score was 8 (1=worst; 10=best). No patient developed foot ulcers. One patient underwent amputation for recurrence. All patients preferred their status over having an amputation.

Conclusions: Objectively and subjectively, division of the major lower-extremity nerves causes acceptable functional deficits in most patients. Resection of affected sciatic nerve (branches) during limb-sparing tumor surgery is an excellent alternative to amputation.

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References

  1. Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy.Ann Surg 1982;196:305–15.

    Article  PubMed  CAS  Google Scholar 

  2. Gebhart MJ, Lane JM, McCormack RR Jr, Glasser D. Limb salvage in bone sarcomas—Memorial Hospital experience.Orthopedics 1985;8:626–35.

    PubMed  CAS  Google Scholar 

  3. Spielmann A, Janzen DL, O’Connell JX, Munk PL. Intraneural synovial sarcoma.Skeletal Radiol 1997;26:677–81.

    Article  PubMed  CAS  Google Scholar 

  4. Thomas JE, Piepgras DG, Scheithauer B, Onofrio BM, Shives TC. Neurogenic tumors of the sciatic nerve. A clinicopathologic study of 35 cases.Mayo Clin Proc 1983;58:640–7.

    PubMed  CAS  Google Scholar 

  5. Hruban RH, Shiu MH, Senie RT, Woodruff JM. Malignant peripheral nerve sheath tumors of the buttock and lower extremity. A study of 43 cases.Cancer 1990;66:1253–65.

    Article  PubMed  CAS  Google Scholar 

  6. Kim DH, Kline DG. Management and results of peroneal nerve lesions.Neurosurgery 1996;39:312–9.

    Article  PubMed  CAS  Google Scholar 

  7. Lee GW, Mackinnon SE, Brandt K, Bell RS. A technique for nerve reconstruction following resection of soft-tissue sarcoma.J Reconstr Microsurg 1993;9:139–44.

    Article  PubMed  CAS  Google Scholar 

  8. Sedel L. The surgical management of nerve lesions in the lower limbs. Clinical evaluation, surgical technique and results.Int Orthop 1985;9:159–70.

    Article  PubMed  CAS  Google Scholar 

  9. Shiu MH, Collin C, Hilaris BS, et al. Limb preservation and tumor control in the treatment of popliteal and antecubital soft tissue sarcomas.Cancer 1986;57:1632–9.

    Article  PubMed  CAS  Google Scholar 

  10. Young JN, Friedman AH, Harrelson JM, Rossitch E Jr, Alston S, Rozear M. Hemangiopericytoma of the sciatic nerve. Case report.J Neurosurg 1991;74:512–5.

    Article  PubMed  CAS  Google Scholar 

  11. Fuchs B, Davis AM, Wunder JS, et al. Sciatic nerve resection in the thigh: a functional evaluation.Clin Orthop 2001;382:34–41.

    Article  PubMed  Google Scholar 

  12. Bell RS, O’Sullivan B, Davis A, Langer F, Cummings B, Fornasier VL. Functional outcome in patients treated with surgery and irradiation for soft tissue tumours.J Surg Oncol 1991;48:224–31.

    Article  PubMed  CAS  Google Scholar 

  13. Davis AM, Sennik S, Griffin AM, et al. Predictors of functional outcomes following limb salvage surgery for lower-extremity soft tissue sarcoma.J Surg Oncol 2000;73:206–11.

    Article  PubMed  CAS  Google Scholar 

  14. Ozaki T, Hillmann A, Lindner N, Winkelmann W. Surgical treatment of bone sarcomas of the fibula. Analysis of 19 cases.Arch Orthop Trauma Surg 1997;116:475–9.

    Article  PubMed  CAS  Google Scholar 

  15. McHorney CA, Ware JE, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups.Med Care 1994;32:40–66.

    Article  PubMed  CAS  Google Scholar 

  16. Wartan SW, Hamann W, Wedley JR, McColl I. Phantom pain and sensation among British veteran amputees.Br J Anaesth 1997;78:652–9.

    PubMed  CAS  Google Scholar 

  17. 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.

    PubMed  CAS  Google Scholar 

  18. Davis AM, Wright JG, Williams JI, Bombardier C, Griffin A, Bell RS. Development of a measure of physical function for patients with bone and soft tissue sarcoma.Qual Life Res 1996;5:508–16.

    Article  PubMed  CAS  Google Scholar 

  19. Davis AM, Bell RS, Badley EM, Yoshida K, Williams JI. Evaluating functional outcome in patients with lower extremity sarcoma.Clin Orthop 1999;358:90–100.

    PubMed  Google Scholar 

  20. 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.

    PubMed  Google Scholar 

  21. Otis JC, Lane JM, Kroll MA. Energy cost during gait in osteosarcoma patients after resection and knee replacement and after above-the-knee amputation.J Bone Joint Surg Am 1985;67:606–11.

    PubMed  CAS  Google Scholar 

  22. Lewis JJ, Brennan MF. Soft tissue sarcomas.Curr Probl Surg 1996;33:817–72.

    Article  PubMed  CAS  Google Scholar 

  23. Panicek DM, Go SD, Healey JH, Leung DH, Brennan MF, Lewis JJ. Soft-tissue sarcoma involving bone or neurovascular structures: MR imaging prognostic factors.Radiology 1997;205:871–5.

    PubMed  CAS  Google Scholar 

  24. Brennan MF. Soft tissue sarcoma involving the sciatic nerve.Br J Surg 2000;87:983.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. From the Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

    A. D. Brooks MD, J. S. Gold MD, D. Graham NP & M. F. Brennan MD

  2. Department of Orthopedic Surgery, Department Orthopedic Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., 10021, New York, NY

    P. Boland MD & J. H. Healey MD (Chief)

  3. Antigenics, Inc., New York, New York

    J. J. Lewis MD, PhD

Authors
  1. A. D. Brooks MD
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  2. J. S. Gold MD
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  3. D. Graham NP
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  4. P. Boland MD
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  5. J. J. Lewis MD, PhD
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  6. M. F. Brennan MD
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  7. J. H. Healey MD
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Correspondence to J. H. Healey MD.

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Brooks, A.D., Gold, J.S., Graham, D. et al. Resection of the sciatic, peroneal, or tibial nerves: Assessment of functional status. Ann Surg Oncol 9, 41–47 (2002). https://doi.org/10.1245/aso.2002.9.1.41

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  • DOI: https://doi.org/10.1245/aso.2002.9.1.41

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