One-Stage Surgical Resection and Functional Reconstruction for Upper Limb Soft Tissue Sarcoma.


Journal

Annals of plastic surgery
ISSN: 1536-3708
Titre abrégé: Ann Plast Surg
Pays: United States
ID NLM: 7805336

Informations de publication

Date de publication:
01 Nov 2024
Historique:
medline: 24 10 2024
pubmed: 24 10 2024
entrez: 24 10 2024
Statut: ppublish

Résumé

Currently, the gold standard of treatment for extremity soft tissue sarcoma (STS) is limb-sparing surgery. When the upper extremity is involved, the functional outcome is frequently poor. A 1-step resection and functional reconstruction would be advisable to obtain a fast recovery. Our study aims at retrospectively analyzing our case series of immediate nerves and tendons reconstructions of the upper limb after STS resection, while combining a review of the literature. A retrospective review was conducted on a consecutive series of patients who underwent an immediate functional reconstruction after STS resection of the upper limb between 2015 and 2022 among the IRCCS Foundation "Istituto Nazionale dei Tumori." The Disabilities of the Arm, Shoulder and Hand (DASH) score was considered the primary outcome. The obtained DASH scores were compared through groups that underwent different reconstructive procedures. The literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) criteria among 3 databases (PubMed, EMBASE, and Cochrane) using the search parameters "(((upper extremity) OR (upper limb)) AND (functional reconstruction) AND (soft tissue sarcoma)." Between 2015 and 2022, 52 patients required a functional reconstruction. The mean follow-up time was 49.63 months. The DASH score analysis reported a mean value of 44.1 ± 26.7. A statistically significant difference was found between groups who underwent different reconstruction techniques, whereas no difference was found regarding exposure to neoadjuvant radiation therapy. The literature review reported few articles focusing on immediate functional reconstruction after STS resection, and only 6 articles were included in the review. Our review aimed at reporting our case series of immediate functional reconstructions after STS of the upper extremity, which is currently the most substantial one reported in literature to set an effective baseline for further studies in the field.

Sections du résumé

BACKGROUND BACKGROUND
Currently, the gold standard of treatment for extremity soft tissue sarcoma (STS) is limb-sparing surgery. When the upper extremity is involved, the functional outcome is frequently poor. A 1-step resection and functional reconstruction would be advisable to obtain a fast recovery. Our study aims at retrospectively analyzing our case series of immediate nerves and tendons reconstructions of the upper limb after STS resection, while combining a review of the literature.
METHODS METHODS
A retrospective review was conducted on a consecutive series of patients who underwent an immediate functional reconstruction after STS resection of the upper limb between 2015 and 2022 among the IRCCS Foundation "Istituto Nazionale dei Tumori." The Disabilities of the Arm, Shoulder and Hand (DASH) score was considered the primary outcome. The obtained DASH scores were compared through groups that underwent different reconstructive procedures. The literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) criteria among 3 databases (PubMed, EMBASE, and Cochrane) using the search parameters "(((upper extremity) OR (upper limb)) AND (functional reconstruction) AND (soft tissue sarcoma)."
RESULTS RESULTS
Between 2015 and 2022, 52 patients required a functional reconstruction. The mean follow-up time was 49.63 months. The DASH score analysis reported a mean value of 44.1 ± 26.7. A statistically significant difference was found between groups who underwent different reconstruction techniques, whereas no difference was found regarding exposure to neoadjuvant radiation therapy. The literature review reported few articles focusing on immediate functional reconstruction after STS resection, and only 6 articles were included in the review.
CONCLUSIONS CONCLUSIONS
Our review aimed at reporting our case series of immediate functional reconstructions after STS of the upper extremity, which is currently the most substantial one reported in literature to set an effective baseline for further studies in the field.

Identifiants

pubmed: 39445877
doi: 10.1097/SAP.0000000000004107
pii: 00000637-202411000-00007
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

575-588

Informations de copyright

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of interest and sources of funding: none declared.

Références

Zahm SH, Fraumeni JF Jr. The epidemiology of soft tissue sarcoma. Semin Oncol. 1997;24:504–514.
Howlader N, Noone AM, Krapcho M, et al., SEER Cancer Statistics Review, 1975–2017, National Cancer Institute. Available at: https://seer.cancer.gov/csr/1975_2017/. Based on November 2019 SEER data submission, posted to the SEER Web site, April 2020 [online]. Accessed May 14, 2024.
Brennan MF, Antonescu CR, Alektiar KM, Maki RG. Management of Soft Tissue Sarcoma. Cham, Switzerland: Springer, 2016. Vol. 1, p. 42.
Moher D, Shamseer L, Clarke M, et al; PRISMA-P Group. Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.
Jester A, Harth A, Wind G, et al. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire: determining functional activity profiles in patients with upper extremity disorders. J hand Surg Br. 2005;30:23–28.
Mundinger GS, Prucz RB, Frassica FJ, et al. Concomitant upper extremity soft tissue sarcoma limb-sparing resection and functional reconstruction: assessment of outcomes and costs of surgery. Hand (N Y). 2014;9:196–204.
Barner-Rasmussen I, Popov P, Böhling T, et al. Microvascular reconstructions after extensive soft tissue sarcoma resections in the upper limb. Eur J Surg Oncol. 2010;36:78–83.
Nelson AA, Frassica FJ, Gordon TA, et al. Cost analysis of functional restoration surgery for extremity soft-tissue sarcoma. Plast Reconstr Surg. 2006;117:277–283.
Kim JY, Subramanian V, Yousef A, et al. Upper extremity limb salvage with microvascular reconstruction in patients with advanced sarcoma. Plast Reconstr Surg. 2004;114:400–408.
Mirous MP, Coulet B, Chammas M, et al. Extensive limb-sparing surgery with reconstruction for sarcoma of the hand and wrist. Orthop Traumatol Surg Res. 2016;102:467–472.
Muramatsu K, Ihara K, Doi K, et al. Sarcoma in the forearm and hand: clinical outcomes and microsurgical reconstruction for limb salvage. Ann Plast Surg. 2009;62:28–33.
Ketola H, Kask G, Barner-Rasmussen I, et al. Measuring functional outcome in upper extremity soft-tissue sarcoma: validation of the Toronto Extremity Salvage Score and the QuickDASH patient-reported outcome instruments. J Plast Reconstr Aesthet Surg. 2022;75:1543–1550.
Wada T, Kawai A, Ihara K, et al. Construct validity of the Enneking score for measuring function in patients with malignant or aggressive benign tumours of the upper limb. J Bone Joint Surg Br. 2007;89:659–663.
Janssen SJ, van Rein EA, Paulino Pereira NR, et al. The discrepancy between patient and clinician reported function in extremity bone metastases. Sarcoma. 2016;2016:1014248.

Auteurs

Arianna Gatto (A)

From the Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Fondazione IRCCS-San Gerardo dei Tintori, Monza.

Erica M Cavalli (EM)

From the Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Fondazione IRCCS-San Gerardo dei Tintori, Monza.

Giorgio Giacomini (G)

Plastic, Reconstructive and Aesthetic Surgery, University of Rome "La Sapienza," Rome.

Stefano Radaelli (S)

Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.

Alessandro Gronchi (A)

Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.

Andrea Marchesi (A)

From the Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Fondazione IRCCS-San Gerardo dei Tintori, Monza.

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