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Cristian A, Keole N, Orada R, Seo J, Guerrina A, Maharaj A. A Narrative Review of the Assessment and Treatment of Physical Impairments Commonly Seen in Sarcoma Cancer Survivors Using a Rehabilitative Approach. Cancers (Basel) 2024; 17:6. [PMID: 39796636 PMCID: PMC11718807 DOI: 10.3390/cancers17010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 12/09/2024] [Accepted: 12/18/2024] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND Sarcomas are a rare, complex group of malignancies characterized by numerous clinical and pathological features. Sarcomas originate from various tissues such as fat, muscle, bone, nerves, blood vessels and connective tissues. Typically, the treatment of sarcomas consists of surgery, chemotherapy, and radiation therapy. The location, type, stage, and treatment of sarcomas contribute to the development of physical impairments affecting joint and limb function, peripheral nerves, strength, and mobility, diminishing physical function and quality of life. Traditionally, rehabilitative therapy has been implemented after cancer treatment to help improve physical impairments imparted from cancer therapy. Recent work in rehabilitative medicine has explored the implementation of rehabilitative therapy prior to beginning cancer treatment (pre-habilitation) to help mitigate the detrimental physical consequences seen in sarcoma patients. OBJECTIVE The objective of this narrative review is to examine the physical impairments affecting sarcoma patients after cancer therapy and the impact of rehabilitative medicine on physical function and quality of life when implemented before and after cancer treatment.
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Affiliation(s)
- Adrian Cristian
- Cancer Rehabilitation, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA;
| | - Nandita Keole
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Phoenix, AZ 85054, USA;
| | - Romer Orada
- Cancer Rehabilitation, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA;
| | - Jayhyun Seo
- Rush Medical College, Chicago, IL 60612, USA;
| | - Austin Guerrina
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA;
| | - Arun Maharaj
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA;
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Generaal JD, Jansen MR, van Leeuwen GL, van Ginkel RJ, Been LB, van Leeuwen BL. Twenty-five years of experience with patient-reported outcome measures in soft-tissue sarcoma patients: a systematic review. Qual Life Res 2024; 33:3189-3211. [PMID: 39259455 PMCID: PMC11599342 DOI: 10.1007/s11136-024-03755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE As the importance of the patient's perspective on treatment outcome is becoming increasingly clear, the availability of patient-reported outcome measures (PROMs) has grown accordingly. There remains insufficient information regarding the quality of PROMs in patients with soft-tissue sarcomas (STSs). The objectives of this systematic review were (1) to identify all PROMs used in STS patients and (2) to critically appraise the methodological quality of these PROMs. METHODS Literature searches were performed in MEDLINE and Embase on April 22, 2024. PROMs were identified by including all studies that evaluate (an aspect of) health-related quality of life in STS patients by using a PROM. Second, studies that assessed measurement properties of the PROMs utilized in STS patients were included. Quality of PROMs was evaluated by performing a COSMIN analysis. RESULTS In 59 studies, 39 PROMs were identified, with the Toronto Extremity Salvage Score (TESS) being the most frequently utilized. Three studies evaluated methodological quality of PROMs in the STS population. Measurement properties of the TESS, Quick Disability of the Arm, Shoulder and Hand (QuickDASH) and European Organization for Research and Treatment for Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) were reported. None of the PROMs utilized in the STS population can be recommended for use based on the current evidence and COSMIN analysis. CONCLUSION To ensure collection of reliable outcomes, PROMs require methodological evaluation prior to utilization in the STS population. Research should prioritize on determining relevant content and subsequently selecting the most suitable PROM for assessment.
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Affiliation(s)
- Jasmijn D Generaal
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Marnix R Jansen
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Goudje L van Leeuwen
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Robert J van Ginkel
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Lukas B Been
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Fukushima T, Okita Y, Watanabe N, Yokota S, Nakano J, Kawai A. Evaluation of clinical factors associated with early postoperative physical function and lower extremity functional impairment in patients with soft tissue sarcoma. Disabil Rehabil 2024; 46:3426-3431. [PMID: 37622737 DOI: 10.1080/09638288.2023.2249413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/21/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE This study aimed to investigate the relationship between various clinical factors and physical function in the early postoperative period in patients with soft tissue sarcomas (STSs) by subjective and objective evaluations. MATERIALS AND METHODS The 90 patients enrolled in this study were classified into five groups according to tumor location: retroperitoneal, gluteal, groin, thigh, and lower leg. The Musculoskeletal Tumor Society (MSTS) score was evaluated at discharge; the timed up-and-go test (TUGT) was performed preoperatively and at discharge. Group comparisons by tumor location were performed. To identify significant factors associated with physical dysfunction, multivariate analysis was performed using an MSTS score of <80% and a change in pre and postoperative TUGT score. RESULTS There were no significant differences between the tumor location and physical function. The change in pre- and postoperative TUGT scores was significantly associated with an MSTS score of <80%. Quadriceps and tibialis anterior muscle resections were significantly associated with the change in pre- and post-operative TUGT scores. CONCLUSIONS The quadriceps and tibialis anterior muscles may affect physical dysfunction after surgery for STSs. Early postoperative rehabilitation should include the identification of resected muscles and functional improvement of residual muscles, possibly with orthotic support for knee extension and ankle dorsiflexion.
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Affiliation(s)
- Takuya Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Yusuke Okita
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Watanabe
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Shota Yokota
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
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Brunetti B, Morelli Coppola M, Tenna S, Salzillo R, Petrucci V, Pazzaglia M, Valeri S, Alloni R, Vincenzi B, Tonini G, Perquoti F, Persichetti P. Thigh reconstruction between form and function: An algorithm for flap selection based on a series of 70 oncological patients. Microsurgery 2024; 44:e31121. [PMID: 37799094 DOI: 10.1002/micr.31121] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Thigh reconstruction after oncological resection represents a challenge in terms of ideal morphological and functional outcomes to aim for. Very few papers presented a comprehensive approach to this topic, most of them being only small cases series. The purpose of this article was to review our institutional experience in the field of thigh soft-tissue reconstruction, proposing an algorithm to choose the most convenient pedicled or free flap approach according to the different clinical scenarios and the specific morpho-functional requirements of the case. PATIENTS AND METHODS The authors retrospectively reviewed patients who received flap reconstruction for thigh soft-tissue defects after oncological resection between 2014 and 2021. Demographic and operative data were recorded. Twelve months post-operatively, patients were asked to rate the esthetic and functional outcomes of the reconstructive procedure on a 5-point Likert scale. Additionally, for patients receiving a free functional muscle transfer to restore quadriceps or hamstring function, recovery was evaluated with the Medical Research Council Scale for Muscle Strength. RESULTS Seventy flap reconstructions of the thigh were, respectively, performed after sarcoma (n = 43), melanoma (n = 13) and non-melanoma skin cancer (n = 14) resection. Pedicled flaps were used in 55 patients: 46 perforator flaps (32 ALT, 4 AMT, 4 PAP, 2 TFL, 2 MSAP, 2 DIEP) and 9 muscle or myocutaneous flaps (4 medial gastrocnemius, 2 gracilis, and 3 VRAM). Microsurgical reconstruction was performed in 15 patients for extensive defects (2 SCIP, 1 latissimus dorsi-LD, 1 thoracodorsal artery perforator-TDAP, 1 ALT, 2 DIEP flaps) or when >50% of the quadriceps or hamstring compartments were resected (eight free functional muscle transfer including five vastus lateralis, two LD, and one rectus femoris). Extensive defect surface, previous irradiation and neoadjuvant chemotherapy appeared to be predictors of free flap reconstruction. Complication (49% vs. 26.6%; p > .05) and readmission rates (32.7% vs. 13.3%; p > .05) were comparable between pedicled and free flap groups, as well as complications severity scores according to Clavien-Dindo classification (1.15 vs. 1.29; p > .05). However, patients with previous irradiation experienced worse outcomes when receiving pedicled rather than free flaps in terms of reintervention (87.5% vs. 28.6%; p = .04) and readmission rates (87.5% vs. 14.29%; p = .01), and severity of surgical complications. Overall patients' satisfaction was high, with esthetic and functional mean score of 4.31 and 4.12, respectively (p > .05). In the FFMT group, M5, M4, M3, and M2 strength was observed in 3, 3, 1, and 1 patients, respectively. CONCLUSION Oncological thigh defects are usually well addressed with pedicled perforator flaps. Microsurgical reconstruction offers reliable and reproducible results in extensive defects and in previously irradiated fields or when functional restoration is indicated.
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Affiliation(s)
- Beniamino Brunetti
- Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marco Morelli Coppola
- Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Stefania Tenna
- Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Rosa Salzillo
- Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Valeria Petrucci
- Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Matteo Pazzaglia
- Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Sergio Valeri
- Operative Research Unit of Soft-tissue Sarcomas Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rossana Alloni
- Operative Research Unit of Specialized General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Specialized General Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Bruno Vincenzi
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Medical Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Tonini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Medical Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Federico Perquoti
- Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Paolo Persichetti
- Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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Farooq MZ, Shafiq MB, Rafi I, Ali S. Limb Salvage Surgery in a Voluminous Malignant Quadriceps Tumor. Cureus 2023; 15:e45717. [PMID: 37868574 PMCID: PMC10590199 DOI: 10.7759/cureus.45717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
It is uncommon for soft tissue sarcomas to develop after adenocarcinoma of the rectum. In a treated rectal adenocarcinoma patient, we encountered a huge malignant quadriceps tumor as leiomyosarcoma and salvaged the limb. A 49-year-old male known case of treated moderately differentiated adenocarcinoma of the rectum presented in the Orthopedic Clinic with a new swelling in his left thigh. MRI of the left lower limb was obtained, and it demonstrated a large 15.8 x 13.2 x 30 cm well-defined mixed solid cystic lesion in the anterolateral aspect of the left mid-thigh without the involvement of adjacent bony cortex. Limb salvage surgery with wide local excision of the tumor was done. The patient was ambulated full weight from the very next day with a Musculoskeletal Tumor Society Score (MSTS) score of 20. Despite the massive size of the tumor, limb salvage was attempted successfully and achieved good functional status.
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Affiliation(s)
- Muhammad Z Farooq
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad B Shafiq
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Ilyas Rafi
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sajid Ali
- Paediatric Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Fukushima T, Okita Y, Watanabe N, Yokota S, Nakano J, Kawai A. Factors associated with physical function in patients after surgery for soft tissue sarcoma in the thigh. BMC Musculoskelet Disord 2023; 24:661. [PMID: 37596604 PMCID: PMC10439620 DOI: 10.1186/s12891-023-06797-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/12/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE This study aimed to examine the validity of the timed up and go test (TUGT), which is a representative, objective, and functional assessment that can evaluate walking speed, strength, and balance, and determine the significant factors associated with physical dysfunction in the early postoperative period in patients with soft tissue sarcomas (STSs). METHODS This retrospective, single-center, observational study conducted at the National Cancer Center Hospital included 54 patients with STSs in the thigh who underwent surgery. The Musculoskeletal Tumor Society (MSTS) score, which subjectively evaluates the affected limb, was evaluated at discharge, and TUGT was performed preoperatively and at discharge. Higher scores indicated good limb function in the MSTS score and poor performance in the TUGT. Spearman's correlation analysis was performed to identify the relationship between the MSTS score and TUGT. A receiver operating characteristic curve was used to calculate the cut-off value of the change in pre- and postoperative TUGT for an MSTS score of ≥ 80%. To examine the significant factors associated with physical dysfunction, multivariate regression analysis was performed using the change in pre- and postoperative TUGT as the dependent variable. RESULTS Postoperative TUGT and the change in pre- and postoperative TUGT were significantly associated with the MSTS score. The cut-off value for the change in pre- and postoperative TUGT for acceptable affected lower-limb function was 3.7 s. Furthermore, quadriceps muscle resection was significantly associated with the change in pre- and postoperative TUGT in the early postoperative period. CONCLUSIONS TUGT could be a useful objective evaluation tool for postoperative patients with STSs. The cut-off value for the change in TUGT can be used to monitor postoperative recovery. If recovery is prolonged, a rehabilitation program can be designed according to the severity of the functional impairment in muscle strength, balance, or gait. In addition, sufficient information should be obtained regarding the presence or absence of quadriceps resection, which has a significant impact on postoperative performance.
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Affiliation(s)
- Takuya Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan.
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan.
| | - Yusuke Okita
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Watanabe
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Shota Yokota
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
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Tanaka A, Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Takazawa A, Komatsu Y, Ideta H, Ishida T, Takahashi J. Muscle strength and functional recovery for soft-tissue sarcoma of the thigh: a prospective study. Int J Clin Oncol 2023:10.1007/s10147-023-02348-4. [PMID: 37133781 DOI: 10.1007/s10147-023-02348-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/25/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND This study aimed to investigate changes in muscle strength and functional outcome before and after surgery for soft-tissue sarcoma of the thigh and to examine the timing of recovery. METHODS From 2014 to 2019, 15 patients who underwent multiple resections of the thigh muscle for soft-tissue sarcoma of the thigh were included in this study. The muscle strength was measured with an isokinetic dynamometer for the knee joint and with a hand-held dynamometer for the hip joint. The functional outcome assessment was based on the Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), European Quality of Life-5 Dimensions (EQ-5D), and maximum walking speed (MWS). All measurements were conducted preoperatively and at 3, 6, 12, 18, and 24 months postoperatively, and the ratio of postoperative to preoperative value was used. A repeated-measures analysis of variance was performed to compare changes over time and to investigate the recovery plateau. Correlations between changes in muscle strength and functional outcomes were also examined. RESULTS The muscle strength of the affected limb, MSTS score, TESS, EQ-5D, and MWS were significantly decreased at 3 months postoperatively. The recovery plateau was subsequently reached at 12 months postoperatively. The changes in muscle strength of the affected limb and functional outcome showed a significant correlation. CONCLUSIONS The estimated postoperative recovery for soft-tissue sarcoma of the thigh is 12 months after surgery.
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Affiliation(s)
- Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yasuo Yoshimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yukiko Komatsu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hirokazu Ideta
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takaaki Ishida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Johansen ML, Eriksrud O, Thorkildsen J, Norum OJ, Wisløff T, Taksdal I, Nilsen TS. Muscle strength characteristics following megaprosthetic knee reconstruction for bone sarcoma. Surg Oncol 2023; 48:101944. [PMID: 37062091 DOI: 10.1016/j.suronc.2023.101944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE To assess muscle strength characteristics in patients with resection and megaprosthetic reconstruction of the knee for bone sarcoma compared to age- and sex-matched controls. METHODS This was a cross-sectional, case-control study. Muscle strength characteristics for knee extension and -flexion were assessed isokinetically at three different joint velocities: 60, 120 and 180°/s, and by the rate of force development (RDFmax) in knee extension. The Toronto Extremity Salvage Score (TESS) was used in patients. RESULTS Eighteen patients (91.6 months postop.) and 18 controls were included. Relative to controls, patients generated maximal torques of 19%, 23% and 23% in knee extension at 60, 120 and 180°/s, respectively. For knee flexion, patients generated maximal torques of 58%, 53% and 60% at 60, 120, and 180°/s, relative to the controls. RDFmax of the operated leg was 2.75 ± 2.13 N/ms, 7.16 ± 4.78 N/ms for the non-operated leg, and 7.95 ± 4.29 N/ms for the controls. The mean TESS score was 84.0. CONCLUSION Patients reached approximately 20% of the maximal knee extension torque. In isometric assessments, they used double the amount of time to generate one-third of the maximal force compared to the controls despite good TESS scores.
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Affiliation(s)
- Merethe Lia Johansen
- Division of Cancer Medicine, Department of Clinical Service, Section for Cancer Rehabilitation, Oslo University Hospital, Oslo, Norway.
| | - Ola Eriksrud
- Institute of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Ole-Jacob Norum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Ingeborg Taksdal
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Tormod S Nilsen
- Institute of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
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Wiffen J, Mah E. Determining functional outcomes after resection and reconstruction of primary soft tissue sarcoma in the lower extremity: A review of current subjective and objective measurement systems. J Surg Oncol 2023; 127:862-870. [PMID: 36683344 DOI: 10.1002/jso.27202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/27/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
The surgical management of soft-tissue sarcoma has evolved significantly over the last two decades due to the routine use of adjunct therapies, with an increased focus on postoperative functional outcome. The literature suffers from methodological inconsistency and use of low quality outcome measures to assess an already heterogeneous population. This article aims to review the most frequently used subjective and objective methods of functional outcome assessment and highlight the current benefits and limitations of these.
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Affiliation(s)
- James Wiffen
- St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Eldon Mah
- Department of Plastic & Reconstructive Surgery, St Vincent's Hospital, Melbourne, Australia
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10
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Gu X, Ricketts S, Mah E. Functional outcomes after single quadriceps muscle resection in patients with soft tissue sarcoma of the anterior compartment of the thigh. ANZ J Surg 2023; 93:288-293. [PMID: 36511137 DOI: 10.1111/ans.18205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Soft tissue sarcoma (STS) occurs most commonly in the anterior compartment of the thigh. Limb salvage surgery is the mainstay of treatment, however, resections frequently involve muscle sacrifice. This study determines the impact of a single quadriceps muscle sacrifice on daily living functions. This is to assist clinical decision-making relating to when a functional reconstruction should be offered over simple soft tissue coverage for these defects. METHODS Patients who underwent single quadriceps resection as part of the management of STS between 2010 and 2020 were selected. Three functional tests were performed: Time Up and Go (TUG), Timed Up and Down Stairs (TUDS) and Toronto Extremity Salvage Score (TESS). The results were compared with age/sex matched healthy reference values and literature cohorts of lower limb STS patients. Correlations between the tests and age and follow-up duration were determined by the Spearman's test. RESULTS The mean TESS, TUG and TUDS results of the 13 patients were 89.6%, 9.8 and 1.01 s/step, respectively. These scores were either similar or significantly better than the comparator values. The TESS score showed no statistical significance compared with patients with no muscle resection. TUG and TUDS scores showed significant positive correlation with each other (ρ = 0.885, P = <0.01) and with age (ρ = 0.646, P = 0.017 and ρ = 0.567, P = 0.043, respectively). CONCLUSION This is the largest documented case series of single quadriceps resection for STS. The study suggests that this group of patients does not show a functional deficit and therefore does not require functional reconstruction.
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Affiliation(s)
- Xinchen Gu
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Parade Fitzroy, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Sophie Ricketts
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Parade Fitzroy, Victoria, Australia
| | - Eldon Mah
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Parade Fitzroy, Victoria, Australia
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Tanaka A, Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Takazawa A, Komatsu Y, Ishida T, Takahashi J. Influence of the adductor compartment resection on muscle strength and postoperative function in soft-tissue sarcoma of the thigh. Jpn J Clin Oncol 2021; 52:370-374. [PMID: 34969097 DOI: 10.1093/jjco/hyab207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To predict the muscle strength and postoperative function for soft-tissue sarcoma arising from the adductor compartment of the thigh. METHODS Between 2003 and 2019, 17 cases that underwent resection of the adductor muscle group (adductor longus, adductor magnus, adductor brevis, gracilis and pectineus) for soft-tissue sarcoma in the adductor compartment of the thigh were included. The muscle strength was measured with an isokinetic dynamometer for the knee joint and with a hand-held dynamometer for the hip joint (ratio of affected to unaffected side). The Musculoskeletal Tumor Society score, Toronto Extremity Salvage Score, European Quality of Life-5 Dimensions and maximum walking speed were used to assess postoperative function and examine correlations with muscle strength. RESULTS In 13 cases that underwent an isolated resection of the adductor compartment, reduced adduction strength correlated with increased number of resected muscles in the adductor muscle group (P < 0.001). Postoperative function was maintained, showing no correlations with adduction strength. In four cases that underwent combined resections of other compartments, a decrease was observed in adduction strength as well as the muscle strength of other resected muscles, in addition to a decline in postoperative function. In the 4 or 5 adductor muscle resection group, the comparison between isolated and combined resection revealed comparable results for adduction strength but a significant decrease in postoperative function for the combined resection group. CONCLUSIONS Postoperative function can be preserved for isolated adductor compartment resection. Combined resections of multiple muscles in other compartments and most adductor muscles may result in decreased postoperative function.
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Affiliation(s)
- Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Yasuo Yoshimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Yukiko Komatsu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Takaaki Ishida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
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den Hollander D, Van der Graaf WTA, Fiore M, Kasper B, Singer S, Desar IME, Husson O. Unravelling the heterogeneity of soft tissue and bone sarcoma patients' health-related quality of life: a systematic literature review with focus on tumour location. ESMO Open 2021; 5:e000914. [PMID: 33082266 PMCID: PMC7577059 DOI: 10.1136/esmoopen-2020-000914] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022] Open
Abstract
Patients with sarcoma experience many physical and psychological symptoms, adversely affecting their health-related quality of life (HRQoL). HRQoL assessment is challenging due to the diversity of the disease. This review aims to unravel the heterogeneity of HRQoL of patients with sarcoma with regard to tumour location and to summarise the used measures in research. English-language literature from four databases published between January 2000 and April 2019 was reviewed. Studies that described adult sarcoma HRQoL outcomes were included and classified according to primary sarcoma location. Eighty-seven articles met the inclusion criteria covering sarcoma of the extremities (n=35), pelvis and axial skeleton (n=9), pelvis and extremities (n=5), head and neck (n=4), retroperitoneum (n=2) and multiple sarcoma locations (n=33), respectively. Urogenital and thoracic sarcoma were lacking. Fifty-four different questionnaires were used, most often cancer-generic or generic HRQoL questionnaires. Patients with sarcoma reported lower HRQoL than the general population. Distinctive patterns of HRQoL outcomes according to tumour location regarding symptoms, physical functioning, disability and psychosocial well-being were identified. In metastatic sarcoma, mostly constitutional symptoms were present. To comprehensively assess HRQoL, a sarcoma-specific measurement strategy should be developed and used covering the heterogeneity of sarcoma including location-specific issues to improve personalised HRQoL assessment in future research and clinical practice.
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Affiliation(s)
- Dide den Hollander
- Medical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands; Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Winette T A Van der Graaf
- Medical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands; Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marco Fiore
- Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Bernd Kasper
- Sarcoma Unit, University of Heidelberg, Mannheim University Medical Center, Mannheim, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre Mainz, Mainz, Germany
| | - Ingrid M E Desar
- Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga Husson
- Medical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom.
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Saebye C, Amidi A, Keller J, Andersen H, Baad-Hansen T. Changes in Functional Outcome and Quality of Life in Soft Tissue Sarcoma Patients within the First Year after Surgery: A Prospective Observational Study. Cancers (Basel) 2020; 12:E463. [PMID: 32079176 PMCID: PMC7072592 DOI: 10.3390/cancers12020463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 01/25/2023] Open
Abstract
Soft tissue sarcoma (STS) patients undergoing surgery may experience reduced functional outcome (FO) and quality of life (QoL) compared to the general population. The aim of this study was to evaluate the development of FO and QoL in patients with STS in the extremities within the first year after first-time limb-sparing surgery. Twenty-nine out of 40 eligible patients were included in the present study. QoL and FO were evaluated by questionnaires while FO was also evaluated by objective tests. Patients were assessed before surgery and at fixed time points within the first year after surgery. Patients with STS in the extremities had an average strength of 82.34% (95% CI: 68.57-96.11) of the expected strength at one year post surgery. Multivariate, repeated ANOVA showed statistically significant reductions in strength in the disease-affected extremity when compared with the healthy side after surgery. Multivariate, repeated ANOVA showed a statistically significant improvement in FO and QoL within the first year post surgery. Limb-sparing surgery for STS significantly reduced strength in the disease-affected extremity and generally reduced FO and QoL in the first months after surgery. Improvements were observed for FO and QoL at one year after surgery.
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Affiliation(s)
- Casper Saebye
- Department of Orthopedic Surgery, Sarcoma Centre of Aarhus University Hospital, Aarhus DK-8200, Denmark
- Department of Experimental Clinical Oncology, Sarcoma Centre of Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Ali Amidi
- Unit for Psychooncology & Health Psychology, Department of Psychology, Aarhus University, Aarhus DK-8000, Denmark
| | - Johnny Keller
- Department of Orthopedic Surgery, Sarcoma Centre of Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Thomas Baad-Hansen
- Department of Orthopedic Surgery, Sarcoma Centre of Aarhus University Hospital, Aarhus DK-8200, Denmark
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14
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McDonough J, Eliott J, Neuhaus S, Reid J, Butow P. Health‐related quality of life, psychosocial functioning, and unmet health needs in patients with sarcoma: A systematic review. Psychooncology 2019; 28:653-664. [DOI: 10.1002/pon.5007] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Joshua McDonough
- School of Public HealthUniversity of Adelaide Adelaide Australia
| | - Jaklin Eliott
- School of Public HealthUniversity of Adelaide Adelaide Australia
| | - Susan Neuhaus
- Discipline of SurgeryUniversity of Adelaide Adelaide Australia
| | - Jessica Reid
- Discipline of SurgeryUniversity of Adelaide Adelaide Australia
| | - Phyllis Butow
- Psycho‐Oncology Co‐operative Research GroupUniversity of Sydney Sydney Australia
- School of PsychologyUniversity of Sydney Sydney Australia
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15
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Saebye CKP, Keller J, Baad-Hansen T. Validation of the Danish version of the musculoskeletal tumour society score questionnaire. World J Orthop 2019; 10:23-32. [PMID: 30705838 PMCID: PMC6354105 DOI: 10.5312/wjo.v10.i1.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/01/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The musculoskeletal tumour society score (MSTS) is a well-known questionnaire for measuring functional outcome in patients with neoplasms in the extremities. Standardized guidelines for cross-cultural translation and validation ensure the equivalence of content between the original and translated versions. The translation and validation provide the possibility to compare different sarcoma populations on an international level. This study is based on the hypothesis that the Danish MSTS questionnaire is a valid tool for measuring the end result after surgery for neoplasms in the extremities.
AIM To validate the Danish version of the upper and lower extremity version of the MSTS.
METHODS The translation of the MSTS was conducted in accordance with international guidelines. Patients operated for sarcomas and aggressive benign tumors were invited to participate in the study. The psychometric properties of the Danish version of the MSTS were tested in terms of validity and reliability and for the risk of floor or ceiling effect. Spearman’s rank coefficient was used to test the validity by comparing with the Toronto Extremity Salvage Score (TESS). The Intraclass Correlation Coefficient (ICC) was used to evaluate inter-rater reliability. Cronbach’s alpha was used to test for internal consistency. Spearman’s rank coefficient was used to compare the MSTS lower extremity version with the objective test, Timed Up and Go (TUG).
RESULTS The upper extremity version demonstrated an ICC of 0.95 in the inter-rater reliability test. The lower extremity version had an ICC of 0.88 in the inter-rater reliability test, respectively. Both MSTS versions showed a ceiling effect. The validity of the MSTS was measured by Spearman’s rank correlation coefficient by comparing the MSTS with the TESS and found it to be of 0.80 (P < 0.01) and 0.83 (P < 0.01) for the upper extremity and lower extremity version, respectively. A Spearman’s rank correlation coefficient of - 0.26 (P < 0.01) was found between the TUG and the MSTS questionnaire. A Spearman’s rank correlation coefficient of - 0.38 (P < 0.01) was found between the TUG and the lower extremity version of the TESS questionnaire.
CONCLUSION The Danish version of the MSTS questionnaires were found to have good reliability and validity, however a substantial ceiling effect was identified.
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Affiliation(s)
- Casper Kloster Pingel Saebye
- Sarcoma Centre of Aarhus University Hospital, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N 8200, Denmark
| | - Johnny Keller
- Sarcoma Centre of Aarhus University Hospital, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N 8200, Denmark
| | - Thomas Baad-Hansen
- Sarcoma Centre of Aarhus University Hospital, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N 8200, Denmark
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16
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Tanaka A, Yoshimura Y, Aoki K, Okamoto M, Kito M, Suzuki S, Takazawa A, Ishida T, Kato H. Prediction of muscle strength and postoperative function after knee flexor muscle resection for soft tissue sarcoma of the lower limbs. Orthop Traumatol Surg Res 2017; 103:1081-1085. [PMID: 28827055 DOI: 10.1016/j.otsr.2017.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/20/2017] [Accepted: 07/04/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Oncological margins and prognosis are the most important factors for operative planning of soft tissue sarcomas, but prediction of postoperative function is also necessary. The purpose of this study was to predict the knee flexion strength and postoperative function after knee flexor muscle resection for soft tissue sarcoma of the lower limbs. MATERIALS AND METHODS Seventeen patients underwent knee flexor muscle resection for soft tissue sarcoma of the lower limbs between 1991 and 2015. The type of resected muscles was surveyed, knee flexion strength (ratio of affected to unaffected side) was evaluated using the Biodex System isokinetic dynamometer, and differences between the type of resected muscles were examined. The Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), European Quality of Life-5 Dimensions (EQ-5D), and Short Form 8 (SF-8) were used to assess postoperative function and examine correlations with flexion strength. The cutoff value for flexion strength to predict good postoperative results was calculated by a receiver operating characteristic (ROC) curve and Fisher's exact test. RESULTS Median flexion strength decreased in the resection of sartorius (97.8%), gracilis (95.4%), gastrocnemius (85.2%; interquartile range (IQR): 85.0-86.2), medial hamstrings (semimembranosus and semitendinosus, 76.2%; IQR: 73.3-78.0), lateral hamstrings (long and short head of biceps femoris, 66.1%; IQR: 65.9-70.4), and bilateral hamstrings (27.3%; IQR: 26.6-31.5). A significant difference was observed between lateral and bilateral hamstrings resection (P=0.049). Flexion strength was associated with lower functional scales (MSTS score, P=0.021; TESS, P=0.008; EQ-5D, P=0.034). Satisfactory function was obtained at a flexion strength cutoff value of 65.7%, and strength remained above the cutoff value up to unilateral hamstrings resection. DISCUSSION Greater knee flexor muscles resection can result in functional deficits that are associated with decreased flexion strength. If continuity of unilateral hamstrings is maintained, good postoperative results can be expected. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- A Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Y Yoshimura
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
| | - K Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - M Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - M Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - S Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - A Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - T Ishida
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - H Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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