Epineural dissection is a safe technique that facilitates limb salvage surgery.
Epineural dissection has been used in our center for the past 19 years as a means of preserving the sciatic nerve when it is closely applied to a soft tissue sarcoma. Our aim in doing this study was to establish if this technique resulted in increased local or systemic recurrence of the tumor. In addition, we assessed functional outcomes. Forty-three patients had an epineural dissection done during primary resection of a malignant thigh tumor. These patients were compared with 44 patients with tumors that were of similar size and grade but distant from the nerve. We also analyzed seven patients who required nerve resection. There was no difference in local or systemic recurrence rates or functional outcomes when epineural dissection was done. Those with nerve resection had worse Musculoskeletal Tumor Society scores but equivalent Toronto Extremity Salvage Scores to those with an epineural dissection. We conclude that epineural dissection (when combined with radiotherapy in a planned multidisciplinary approach to limb salvage) is both a safe and effective procedure to preserve the sciatic nerve and that nerve resection should be limited to situations where the nerve is completely encased in tumor.


METHODS
Prognostic study, Level II-2 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.
Clarkson
Paul W
PW
University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.
Griffin
Anthony M
AM
Catton
Charles N
CN
O'Sullivan
Brian
B
Ferguson
Peter C
PC
Wunder
Jay S
JS
Bell
Robert S
RS
D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D019317:Evidence-Based Medicine; D023821:Limb Salvage / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery; D012584:Sciatic Nerve / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000601:surgery; D013848:Thigh / Q000294:innervation / Q000601:surgery*