FUNCTIONAL OUTCOME FOLLOWING EXCISION OF LARGE VOLUME SOFT TISSUE SARCOMA INVOLVING THE SCIATIC NERVE

Abstract

Purpose: To quantify the functional outcome of patients who were known to have sciatic nerve involvement pre-operatively and went on to have nerve preserving surgery utilising a planned marginal excision with epineurectomy.

Materials and Methods: Ten patients with large volume posterior thigh soft tissue sarcoma with known sciatic nerve involvement were reviewed between 1997 and 2004. Nine underwent surgery with extended epineurectomy of the sciatic nerve and planned marginal excision.

All patients underwent staging and follow up at Sarcoma Clinic with functional assessment and TESS evaluation.

Results: There were seven low and two high grade posterior thigh tumours of which nine were liposarcoma and 1 haemangiopericytoma. Two were recurrent and eight primary. There were five men and five women with a mean age of 77.

Nine patients underwent planned marginal excision. Sciatic nerve involvement was 13–30cm in eight cases and in one case the sciatic nerve was abutting the tumour throughout its length. There was soft tissue reconstruction in three cases using fascial adductor or gracilis graft for sciatic nerve cover and one with superficial femoral nerve and vein resection requiring ipsilateral saphenous reconstruction. The remainder underwent direct primary reconstruction.

Four patients underwent radiotherapy 46–60 Gy.

There was no local recurrence of disease within 14 – 96m follow-up. There was one patient with post radiation wound breakdown that resolved.

Three patients have died of unrelated causes. To date there has been no evidence of local recurrence of disease at FU.

Conclusion: Planned marginal excision of low grade large volume posterior thigh sarcomas with extensive sciatic nerve involvement can be successfully treated with preservation of the sciatic nerve without significant morbidity and resultant good limb function.