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Sarcoma Size and Limb Dimensions Predict Complications, Recurrence, and Death in Patients with Soft Tissue Sarcoma in the Thigh: A Multidimensional Analysis

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Abstract

Background

Limb-sparing resections of thigh soft tissue sarcomas (STSs) can result in adverse outcomes. Identifying preoperative predictors for wound healing complications, tumor recurrence, and mortality is crucial for informed reconstructive decision-making. We hypothesized that preoperative measurements of thigh and tumor dimensions could serve as reliable indicators for postoperative complications, recurrence, and death.

Patients and Methods

In this retrospective cohort study conducted from March 2016 to December 2021, we analyzed patients undergoing thigh STS excisions followed by reconstruction. Preoperative magnetic resonance imaging or computed tomography scans provided necessary thigh and tumor dimensions. Univariate and multivariate regression assessed relationships between these dimensions and postoperative outcomes, including complications, recurrence, and death.

Results

Upon the analysis of 123 thighs, we found thigh width to be highly predictive of postoperative complications, even surpassing body mass index (BMI) and retaining significance in multivariate regression [odds ratio (OR) 1.19; 95% CI 1.03–1.39; p = 0.03]. Sarcoma-to-thigh width and thickness ratios predicted STS recurrence, with the thickness ratio retaining significance in multivariate regression (OR 1.03; 95% CI 1.001–1.05; p = 0.041). Notably, greater thigh thickness was independently protective against mortality in multivariate analysis (OR 0.80; 95% CI 0.65–0.98; p = 0.030).

Conclusions

Thigh width outperformed BMI in association with postoperative complications. This may create an opportunity for intervention, where weight loss can play a role during the neoadjuvant therapy period to potentially reduce complications. Sarcoma-to-thigh width and thickness ratios, particularly the latter, hold substantial predictive value in terms of STS recurrence. Moreover, thigh thickness is an independent predictor of survival.

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Acknowledgement

We thank Laura Russell, Research Medical Library, for her editorial support.

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Authors and Affiliations

  1. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Rami Elmorsi MD, Luis Camacho MD, Gordon S. Tilney PA-C, Margaret S. Roubaud MD & Alexander F. Mericli MD

  2. Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    David D. Krijgh MD

  3. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Heather Lyu MD, MBI, Raymond S. Traweek MD & Christina L. Roland MD, MS

  4. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Russell G. Witt MD, MAS

Authors
  1. Rami Elmorsi MD
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  2. Luis Camacho MD
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  4. Gordon S. Tilney PA-C
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  7. Russell G. Witt MD, MAS
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  8. Margaret S. Roubaud MD
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  10. Alexander F. Mericli MD
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Correspondence to Alexander F. Mericli MD.

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Disclosures

Dr. Alexander F. Mericli serves as a consultant for Mentor Worldwide LLC, Allergan, Inc, and Destiny Pharma, PLC.

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Elmorsi, R., Camacho, L., Krijgh, D.D. et al. Sarcoma Size and Limb Dimensions Predict Complications, Recurrence, and Death in Patients with Soft Tissue Sarcoma in the Thigh: A Multidimensional Analysis. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15183-2

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  • DOI: https://doi.org/10.1245/s10434-024-15183-2

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