title: The risk of postoperative complications and functional impairment after multimodality treatment for limb and trunk wall soft-tissue sarcoma: Long term results from a monocentric series.
abstract: OBJECTIVE
  Conservative surgery for soft-tissue sarcoma (STS) within multimodality treatment attempts to reconcile two contradictory requirements: assuring a good oncological outcome through a wide resection and preserving the function. The aim of our study is to verify whether our conservative approach to STS met these objectives.
  
  
  METHODS
  A retrospective database analysis was performed in adults with primary limb or trunk wall STS operated in a single center from 1989 to 2012. Predictive factors for postoperative complications and functional impairment were tested in a multivariate analysis.
  
  
  RESULTS
  728 patients were operated (resection R0: 68%). Neoadjuvant chemotherapy (NAC) was given to 28%, postoperative radiotherapy to 70% of patients. Median follow-up was 103 months. At five years, overall survival was 80% and local recurrences 11%. Major postoperative complications occurred in 8% and functional impairment in 13% of the patients. Independent predictive factors for postoperative complications were American Society of Anesthesiologist classes 2 and 3 (OR: 2.3, CI: 1.2-4.5 and 4.0 CI: 1.7-9.3), tumor size >80 mm (OR: 2.5, CI: 1.3-4.9), tumor site (trunk wall/lower limb, OR: 4.1, CI: 1.3-13.6) and multifocal/multicompartmental spread (OR: 2, CI: 1.1-3.6). Independent predictive factors for function impairment were postoperative complications (OR: 5.3, CI: 2.8-10.1), NAC (OR: 3.6, CI: 2.2-5.8), and bone or neurovascular involvement (OR 3.3, CI 2.0-5.3), whereas Early Rehabilitation after Surgery (ERAS) improved outcome (OR: 0.5, CI: 0.3-0.9).
  
  
  CONCLUSIONS
  Postoperative complications induced functional impairment. They may be reduced by acting on comorbidity factors and careful tumor evaluation prior to surgery. Furthermore, ERAS measures improved function.
authors.affiliation: Department of Surgery, Institut Bergonié, 229 cours de l'Argonne, F-33076, Bordeaux, France. Electronic address: e.stoeckle@bordeaux.unicancer.fr.
authors.forename: E
authors.initials: E
authors.lastname: Stoeckle
authors.affiliation: Department of Surgery, Institut Bergonié, 229 cours de l'Argonne, F-33076, Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Michot
authors.affiliation: Department of Physiotherapy and Re-education, Institut Bergonié, 229 cours de l'Argonne, F-33076, Bordeaux, France.
authors.forename: L
authors.initials: L
authors.lastname: Rigal
authors.affiliation: Department of Anaesthesia and Reanimation, Institut Bergonié, 229 cours de l'Argonne, F-33076, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Babre
authors.affiliation: Department of Radiotherapy, Institut Bergonié, 229 cours de l'Argonne, F-33076, Bordeaux, France.
authors.forename: P
authors.initials: P
authors.lastname: Sargos
authors.affiliation: Department of Radiotherapy, Institut Bergonié, 229 cours de l'Argonne, F-33076, Bordeaux, France.
authors.forename: B
authors.initials: B
authors.lastname: Henriques de Figueiredo
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, 229 cours de l'Argonne, F-33076, Bordeaux, France.
authors.forename: V
authors.initials: V
authors.lastname: Brouste
authors.affiliation: Department of Medical Oncology, Institut Bergonié, 229 cours de l'Argonne, F-33076, Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Italiano
authors.affiliation: Department of Medical Oncology, Institut Bergonié, 229 cours de l'Argonne, F-33076, Bordeaux, France.
authors.forename: M
authors.initials: M
authors.lastname: Toulmonde
authors.affiliation: Department of Pathology, Institut Bergonié, 229 cours de l'Argonne, F-33076, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Le Loarer
authors.affiliation: Department of Medical Imaging, Institut Bergonié, 229 cours de l'Argonne, F-33076, Bordeaux, France.
authors.forename: M
authors.initials: M
authors.lastname: Kind
mesh_terms: D034861:Abdominal Wall; D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005121:Extremities / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D008297:Male; D015080:Mesna / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000473:pathology / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D035441:Thoracic Wall; D060726:Torso / Q000601:surgery*; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D003606:Dacarbazine; D004317:Doxorubicin; D015080:Mesna; D007069:Ifosfamide
keywords: Enhanced recovery after surgery; Functional outcome; Morbidity; Multimodal treatment; Soft-tissue sarcoma; Surgery