BACKGROUND Despite the goal of an acceptable functional result, the surgical treatment of soft-tissue sarcoma can portend a prolonged course of recovery. More comprehensive data on the expected course of recovery following extremity sarcoma surgery are needed to help to inform physicians and patients. The purpose of the present study was to describe the typical course of functional recovery following limb-salvage resection of a soft-tissue sarcoma and to identify factors associated with a delayed postoperative course of recovery. METHODS A retrospective review of a prospectively maintained institutional database was performed for all patients undergoing surgical treatment with limb salvage of a soft-tissue sarcoma of the extremities or pelvis with at least 1 year of follow-up after the definitive surgical procedure. All patients were required to have preoperative functional outcomes recorded for either the Toronto Extremity Salvage Score (TESS) or the Musculoskeletal Tumor Society (MSTS) score and functional outcome measures at 1 year postoperatively. The primary outcome measures were time to recovery and maximal functional improvement. RESULTS In this study, 916 patients met inclusion criteria following surgical resection of a soft-tissue sarcoma of the extremities. The median follow-up was 74 months. Patients typically achieved a return to their baseline preoperative level of function for all functional outcome measures by 1 to 2 years and achieved maximal functional recovery by 2 years postoperatively. Older age, female sex, deep tumor location, larger tumor size, pelvic location, osseous resection, motor nerve resection, free and/or rotational soft-tissue coverage, and postoperative complications were independently associated with worse TESS and/or MSTS scores (p ≤ 0.05). Tumor recurrence was associated with worse functional outcomes scores. An analysis was performed to determine which patients had a prolonged course of recovery (i.e., were considered to still be recovering). Older age, female sex, larger tumor size, osseous resection, and motor nerve resection were associated with a delayed course of recovery (p ≤ 0.04). Complications and tumor recurrence were associated with delayed functional recovery across all domains. CONCLUSIONS Most patients will achieve maximal recovery by 2 to 3 years following surgical resection for soft-tissue sarcoma of the extremities. Older age, female sex, larger tumor size, osseous resection, motor nerve resection, postoperative complications, and tumor recurrence portend poorer functional outcomes and a delayed course of recovery. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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绘制四肢软组织肉瘤保肢手术后的恢复过程。


背景尽管软组织肉瘤的手术治疗目标是获得可接受的功能结果，但它可能预示着长期的恢复过程。需要关于四肢肉瘤手术后预期恢复过程的更全面的数据，以帮助告知医生和患者。本研究的目的是描述软组织肉瘤保肢切除后功能恢复的典型过程，并确定与术后恢复过程延迟相关的因素。方法 对所有接受四肢或骨盆软组织肉瘤保肢手术治疗的患者进行前瞻性维护的机构数据库的回顾性审查，并在最终手术后至少随访 1 年。所有患者都需要记录术前功能结果，包括多伦多肢体挽救评分 (TESS) 或肌肉骨骼肿瘤协会 (MSTS) 评分以及术后 1 年的功能结果测量。主要结果指标是恢复时间和最大功能改善。结果 在这项研究中，916 名患者在手术切除四肢软组织肉瘤后符合纳入标准。中位随访时间为 74 个月。患者通常在 1 至 2 年内实现所有功能结果测量的功能恢复至术前基线水平，并在术后 2 年内实现最大功能恢复。 年龄较大、女性、肿瘤位置较深、肿瘤较大、骨盆位置、骨切除、运动神经切除、游离和/或旋转软组织覆盖以及术后并发症与较差的 TESS 和/或 MSTS 评分独立相关（p ≤0.05）。肿瘤复发与较差的功能结果评分相关。进行分析以确定哪些患者的恢复过程较长（即被认为仍在恢复中）。年龄较大、女性、较大的肿瘤尺寸、骨切除和运动神经切除与恢复过程延迟相关（p ≤ 0.04）。并发症和肿瘤复发与所有领域的功能恢复延迟相关。结论 四肢软组织肉瘤手术切除后，大多数患者将在 2 至 3 年内实现最大康复。年龄较大、女性、肿瘤较大、骨切除、运动神经切除、术后并发症和肿瘤复发预示着功能结果较差和恢复过程延迟。证据级别 预后 IV 级。有关证据级别的完整描述，请参阅作者须知。