Predictors of functional outcomes following limb salvage surgery for lower-extremity soft tissue sarcoma

Background and Objectives: Patient function has been conceptualized by clin ical measures such as joint motion, muscle strength, disability, and genera l health status. The purpose of the current study was to evaluate tumor and treatment variables predictive of these conceptually different posttreatme nt functional outcomes in patients treated with limb preservation surgery f or lower-extremity soft tissue sarcoma. Methods: One hundred seventy-two patients with minimum 1-year follow-up wer e evaluated using the following outcomes: impairment, measured by the 1987 and 1993 versions of the Musculoskeletal Tumor Society Rating Scale (MSTS); disability, measured by the Toronto Extremity Salvage Score (TESS); and ge neral health status, using the Short Form-36 (SF-36). Tumor and treatment-r elated variables (age, gender, presenting disease status, anatomic site, tu mor size, grade, depth, prior excision, irradiation, bone resection, motor nerve sacrifice, and complications) were extracted from the STS database. Results: Large tumor size, bone resection, motor nerve resection, and compl ications were predictive of lower MSTS 1987 and 1993 scores. Patients with large, high-grade tumors who required motor nerve resection were more disab led, as reflected by lower TESS scores. Only age and prior surgery were adv erse predictors of SF-36 score. Conclusions: These results demonstrate that different factors are predictiv e of different patient outcomes, specifically, impairment, disability, and general health status. It is important to define function when counseling p atients regarding their potential recovery based on tumor and treatment-rel ated variables. (C) 2000 Wiley-Liss, Inc.