The management and outcome of large volume liposarcomas encasing the sciatic nerve

Abstract This paper outlines the oncological outcomes of patients with large volume liposarcomas of the posterior thigh who underwent nerve preserving surgery utilising epineural dissection. Thirty-seven consecutive patients (group I) with a mean age of 66.2 (31 to 96) were surgically treated with a planned marginal resection and epineurectomy for liposarcoma with known sciatic nerve involvement between March 1997 and January 2015. The mean follow up was 79 months (15 to 192). All patients underwent MDT preoperative assessment and staging, with follow up in Sarcoma Clinic. Pre-operative function was assessed by applying the Toronto extremity salvage score (TESS). Oncological and functional outcomes were recorded. 24, 6, and 7 liposarcomas of grades 1, 2, and 3 respectively were included with mean volume 1859cm 3 . Sciatic nerve involvement extended for 13–30 cm; in one case the nerve was abutting the tumour throughout its length. Soft tissue reconstructive surgery was required in 3 cases. The remainder underwent direct primary closure. Seventeen patients underwent postoperative adjuvant radiotherapy 46–60 Gray and three received chemotherapy. There was local recurrence of disease in three patients. One patient had post radiation wound breakdown treated non-operatively. Three patients died of an unrelated cause. When compared to a cohort of 37 patients without sciatic nerve involvement (group II), there were no significant differences in local and systemic recurrence rate or postoperative survival. In conclusion sciatic nerve preserving surgery is both possible and safe when using a planned epineural dissection in large volume tumours encasing the sciatic nerve.