Introduction: Malignant peripheral nerve sheath tumors (MPNST) constitute roughly a tenth of all soft tissue malignancies in adults. MPNSTs behave aggressively with high rates of recurrence and poor overall survival, requiring extensive extents of resection. Prior studies have found that reduced functional outcomes have been associated with mortality. However, no work has been done with MPNSTs.
Methods: Data on all patients who underwent MPNST resection at a single institution between January 1st, 2011- December 31st, 2023, was retrospectively collected via chart review. Univariate analyses were conducted between demographic and clinical factors with postoperative pain, sensory deficits, weakness, and gait disturbances at last follow up greater than three months. Logisitic regression controlling for age, race, and gender was done on variables found to be significant on univariate. Kaplan Meyer curves were calculated to identify differences in mortality rates between patients with and without functional deficits at last follow up.
Results: Our final cohort consisted of 44 patients. On univariate analysis, patients with increased comorbidity noted by Charlson Comorbidity Index (p=0.0154) and increased length of stay (LOS) had postoperative pain, while those with subtotal resections were trending towards significance (p=0.0743). Patients who were smokers had higher odds of having postoperative sensory deficits (OR [95%CI]: 1.27 [1.03-1.57] and weakness (OR [95%CI]: 1.57 [1.06-1.72]. Patients who were not ambulatory were more likely to be older (Estimate [95%CI]: 0.06 [0.04-0.08]) and have preoperative weakness (Estimate [95%CI]: 0.53 [0.29-0.76]), while less likely to have received a gross total resection (Estimate [95%CI]: -1.43 [-2.09- -0.77]). No postoperative deficit was associated with survival on Kaplan Meyer.
Conclusion : Smoking status, preoperative deficits, and surgical factors are associated with postoperative functional deficits for MPNST patients. Although surgeons must maximize MPNST surgical resection to limit tumor recurrence, preserving functionality should be considered.
.jpg)
