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 尽管目标是可接受的功能结果，但软组织肉瘤的手术治疗可能预示着漫长的恢复过程。需要有关肢体肉瘤手术后预期恢复过程的更全面数据，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术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进行回顾性评价，并在根治性外科手术后至少随访 1 年。所有患者都需要在术后 1 年记录多伦多肢体挽救评分 （TESS） 或肌肉骨骼肿瘤协会 （MSTS） 评分和功能结局指标的术前功能结局。主要结局指标是恢复时间和最大功能改善。结果 在这项研究中，916 例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 年内所有功能结局指标恢复到术前基线功能水平，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、盆腔位置、骨切除术、运动神经切除术、游离和/或旋转软组织覆盖以及术后并发症与 TESS 和/或 MSTS 评分较差独立相关 （p ≤ 0.05）。肿瘤复发与较差的功能结局评分相关。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）。年龄较大、女性、肿瘤较大、骨切除和运动神经切除术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 大多数患者在手术切除四肢软组织肉瘤后 2 至 3 年内可实现最大恢复。高龄、女性、肿瘤较大、骨切除术、运动神经切除术、术后并发症和肿瘤复发预示着功能结局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，请参阅作者说明。