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The Influence of Anatomic Location on Functional Outcome in Lower-Extremity Soft-Tissue Sarcoma

From the University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto and Princess Margaret Hospital, Toronto, Canada.

Correspondence: Address correspondence and reprint requests to: A. M. Davis, PhD, Room 1119, Toronto Rehabilitation Institute, 550 University Avenue, Toronto, Ontario, Canada M5G 2A2; Fax: 416-597-3031; e-mail: davis.aileen{at}torontorehab.on.ca

Background: The purpose of this study was to explore the relationship between the anatomical location of lower-extremity soft-tissue sarcoma and functional outcome.

Methods: Function was evaluated with the Musculoskeletal Tumor Society (MSTS 1993) score and Toronto Extremity Salvage Score (TESS); 207 patients (median age, 54 years) were eligible. The median maximum tumor diameter was 8.0 cm; 58 tumors were superficial and 149 were deep. Nine locations based on anatomical compartments were defined: 6 tumors were in the groin/femoral triangle; 8, the buttock; 52, the anterior thigh; 22, the medial thigh; 20, the posterior thigh; 10, the popliteal fossa; 13, the posterior calf; 11, the anterolateral leg; and 7, the foot or ankle.

Results: Treatment of superficial tumors did not lead to significant changes in MSTS score (mean, 90.6% preoperatively vs. 93.0% postoperatively; P = .566) or TESS (mean, 86.4% preoperatively vs. 90.9% postoperatively; P = .059). Treatment of deep tumors lead to significant reductions in MSTS score and TESS (mean MSTS, 86.9% preoperatively vs. 83.0% postoperatively; P = .001; and mean TESS, 83.0% preoperatively vs. 79.4% postoperatively; P = .015). Anatomical location was not a significant predictor of aggregated MSTS and TESS evaluations. Exploratory analysis showed variation in MSTS pain and gait handicap or limp items and TESS dressing, sitting, bending, and bathing items by anatomical location.

Conclusions: The treatment of superficial tumors does not lead to significant changes in MSTS score or TESS. Anatomical location is not a significant predictor of aggregated MSTS and TESS evaluations. However, there is variation in MSTS and TESS item scores across anatomical locations.

Key Words: Lower extremity • Soft-tissue sarcoma • Anatomical site • Functional outcome

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