Partial hand preservation for large soft tissue sarcomas of the hand Journal Article

Authors: Puhaindran, M. E.; Steensma, M. R.; Athanasian, E. A.
Article Title: Partial hand preservation for large soft tissue sarcomas of the hand
Abstract: Purpose: Hand amputations cause marked functional loss for patients. In patients with large soft tissue sarcomas of the hand, partial hand preservation is extremely challenging for surgeons attempting a complete resection of the tumor with negative resection margins. We conducted this review to examine the oncologic outcome, including local recurrence rate and patient overall survival, and functional outcome after resections for large soft tissue sarcomas with partial hand preservation. Methods: We performed a retrospective review of all patients with soft tissue sarcomas of the hand treated at our institution from 1995 to 2007. We identified 8 patients who had tumors at least 5 cm in maximum dimension and had tumor resection with partial hand preservation. The mean age at the time of surgery was 49 years (range, 10-80 years). Two patients had myxofibrosarcoma, 2 patients had synovial sarcoma, 2 patients had malignant fibrous histiocytoma, 1 patient had a malignant peripheral nerve sheath tumor, and 1 patient had a liposarcoma. Two patients had low-grade tumors, and 6 patients had high-grade tumors. Two patients had American Joint Committee on Cancer stage 1b tumors, and 6 patients had American Joint Committee on Cancer stage 3 tumors. No patients had distant metastases at the time of surgery. Hand function was evaluated using Musculoskeletal Tumor Society criteria. Results: Of the 8 patients, 1 died of distant metastatic disease, 1 developed local tumor recurrence and is alive with locally recurrent disease, and the other 6 patients are completely disease-free. The mean Musculoskeletal Tumor Society score was 26 (range, 19-29), with the 2 patients who had received double-ray amputations having the lower scores (19 and 24). Conclusions: Partial hand preservation is possible in selected patients with large soft tissue sarcomas of the hand, obtaining low local recurrence rates, good overall survival, and good functional outcome. However, all effort should be made to achieve negative resection margins. Type of study/level of evidence: Therapeutic IV. © 2010 American Society for Surgery of the Hand.
Keywords: adolescent; adult; child; clinical article; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; cancer surgery; hand function; limb salvage; retrospective studies; young adult; overall survival; cancer staging; outcome assessment; recurrence risk; follow-up studies; neoplasm staging; cohort studies; neoplasm recurrence, local; oncology; retrospective study; distant metastasis; risk assessment; sarcoma; tumor recurrence; scoring system; amputation; soft tissue sarcoma; malignant fibrous histiocytoma; synovial sarcoma; nerve sheath tumor; prosthesis; soft tissue neoplasms; liposarcoma; preservation; hand; hand preservation; hand amputation; hand disease; fibromyxosarcoma; hand sarcoma; partial hand preservation; peripheral nerve sheath cancer; arm; artificial limbs; prosthesis fitting
Journal Title: Journal of Hand Surgery
Volume: 35
Issue: 2
ISSN: 0363-5023
Publisher: Elsevier Inc.  
Date Published: 2010-02-01
Start Page: 291
End Page: 295
Language: English
DOI: 10.1016/j.jhsa.2009.11.014
PUBMED: 20141899
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: JHSUD" - "Source: Scopus"
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