The Need for Reconstructive Surgery in Soft Tissue Sarcomas - Long-Term Functional Results and Quality of Life

The defect after resection of soft tissue sarcomas (STS) often requires reconstructive surgical procedures mostly allowing limb salvage.The prognosis of STS is mainly dependent on the tumour stage.Limited information exists about the long-term outcome and the influence of reconstructive surgery on the functional outcome and the quality of life.From 1993 until 2009, 203 patients (120 men, 83 women, mean age 52 years) with soft tissue sarcomas were treated surgically.The necessary reconstructive surgical procedures were analysed.To get information about the long-term outcome, 86 patients (51 men, 35 women) treated between 1993 and 1999 (follow-up > 10 years) were analyzed.The oncological outcome (local recurrences, metastases, overall survival) of 30 stage I-, 52 stage II-and 4 stage III-tumours was determined.Functional outcome and quality of life of the survivors were measured using the MSTS-criteria and the EORTC-QLQ-C-30 questionnaire after a mean follow-up of 144 months.Different reconstructive procedures were necessary in 64 out of the 203 cases: 17 simple mesh graft, 32 muscle flaps, 3 tendon transfers, 8 vascular grafts and 4 bony reconstructions.The long-term survival was mainly influenced by the tumour stage.Survival rates of the stage II tumours were 56.5% and 49% after 5 and 10 years.Thirty-six patients of the long-term follow-up group were dead after 10 years: 29 of their malignancy and 6 of other diseases.The 50 long-term survivors presented good results for MSTS (mean score 82.4) and EORTC-QLQ-C-30 (mean score 79.8), the results were independent on the need of reconstructive surgery.Concluding, different reconstructive surgical procedures can be necessary to close the defect after adequate resection of STS.The long-term functional results and the quality of life are not dependent on the procedure performed.Therefore, oncological and not functional aspects have to determine the extent of the adequate surgery.