Limb-Sparing Surgery for Extremity Sarcomas: Outcomes and Functional Analysis in a Six-Year Experience
Bibliographic record
Abstract
There are approximately 8300 cases of sarcomas annually, with 50% occurring in the extremities. Currently, limb-sparing surgery is preferred over limb amputation. Extremity sarcomas at the authors' institution undergo limb-sparing surgery, when possible, with wide margin resection, immediate soft-tissue reconstruction, and adjuvant therapy. This report was a retrospective outcomes study and functional analysis of these patients over 6 years. Between February, 1998 and May, 2004 (75 months), 112 patients (72 males and 40 females, with ages 52.5 years ± 18.5 years) underwent salvage of 115 limbs (75 lower, 40 upper extremities). The thigh was the most common location (n = 44); 66% of the tumors were high-grade (n = 74); and 37.5% were MFH (n = 35). The average tumor size at resection was 6.8 ± 5.5 cm. The rectus abdominis, latissimus dorsi, gastrocnemius, and fasciocutaensou flaps accounted for 81.4% of the flaps used. Resection took 3.4 ± 1.7 hr, and reconstruction took 4.3 ± 2.1 hr. Ninety-five patients had neoadjuvant therapy, with 55 receiving pre- and 77 receiving postoperative therapy. Twenty-nine patients had both pre- and postoperative treatments. Brachytherapy (n = 26) was started on postoperative day 7.0 ± 1.5. Follow-up has been from 1 to 69 months with 10 patients lost to follow-up and 16 deaths. Twenty-seven developed metastasis, the most common location being the lung (n = 21). Of the 122 flaps, 42 were free with two acute losses (5%) and 4 late losses (10%). All pedicle flaps survived (overall flap survival: 95.1%). Fifty-six patients (50%) had minor or major wound complications, most commonly seromas. One patient (1%) required an above-knee amputation because of refractory periprosthetic infections. Postoperative function was analyzed with the Toronto Extremity Salvage Score. Of the 103 patients with at least 6 months recovery, 83 were known to be alive and 53 (64%) completed the survey at a mean of 27.6 months post surgery. The mean TESS was 83.2 (UE = 89.3; LE = 79.2, ns), indicating slight disability in daily activities (100 = no difficulty; 75 = slight difficulty). Patients' self-rated disability score was 4.3 (no disability = 5; slight = 4). Patients who had three different modalities of adjuvant therapy were more likely than those with only one modality to have a lower TESS, although not significantly (p = 0.057). There was no significance in TESS with respect to age, sex, adjuvant therapy, or type of adjuvant therapy). This study showed that even with major surgery, patients noted only limited disability. Despite a high rate of minor wound complications, limb-preservation surgery maintains the patient's ability to achieve a high level of functionality.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".