The postoperative functional outcome (FO) of patients with lower-extremity soft tissue sarcoma (STS) treated with surgery may improve to meet the baseline preoperative FO during long-term follow-up, according to results from a systematic literature review published in the Annals of Surgical Oncology.

As salvage surgery increases in STS and amputations become rarer, understanding how FO is measured and whether methods have been tested for validity is important. In this systematic literature review, researchers searched Scopus, Web of Science, and Pubmed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

From 3461 publications, 37 studies met the inclusion criteria. Inclusion criteria were publications about patients with surgically treated lower extremity STS with measured FO. Exclusion criteria were publications in non-English languages, studies with fewer than 20 lower-extremity STS patients, and duplications.

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The Toronto Extremity Salvage Score (TESS) was the most frequently used measure of FO (16 studies), followed by the Musculoskeletal Tumor Society (MSTS) score 1993 (12 studies).

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The pooled average TESS score was 83.3 of 100, and the pooled average MSTS 1993 score was 86.2 of 100, scores that the authors described as “relatively good.”

Clinician-reported outcomes were used in 27 studies, patient-reported outcomes in 20 studies, and observer-reported outcomes in 2 studies.

This study noted that of the 10 previously reported measures of FO, only 3 provided validated FO scores, and the quality of methods in the studies was generally low.

“Functional outcome scores seem to return to pretreatment levels 1 year after surgery,” wrote the investigators. “Thus, measurement of FO also should be performed at least once 1 year after surgery or later in addition to other time points. This review indicates that quality is lacking in FO studies examining surgical treatment of lower-extremity STS.”


Kask G, Barner-Rasmussen I, Repo JP, et al. Functional outcome measurement in patients with lower-extremity soft tissue sarcoma: a systematic literature review [published online August 12, 2019]. Ann Surg Oncol. doi: 10.1245/s10434-019-07698-w