Non-oncological outcomes following limb salvage surgery in patients with knee sarcoma: a scoping review

Abstract

Purpose

Limb salvage surgery is a surgical procedure for tumour resection in bone and soft-tissue cancers. Guidelines aim to preserve as much function and tissue of the limb as possible. Surgical outcome data is routinely available as part of surgical reporting processes. What is less known are important non-oncological outcomes throughout recovery from both clinical and patient perspectives. The objective of this review was to explore non-oncological outcomes in patients diagnosed with sarcoma around the knee following limb salvage surgery.

Materials and Methods

A scoping review methodology was used, and results analysed using CASP checklists.

Results

Thirteen studies were included and following appraisal and synthesis, three themes emerged as providing important measures intrinsic to successful patient recovery: (1) physical function, (2) quality of life and, (3) gait and knee goniometry. Specifically, patients develop range of motion complications that alter gait patterns and patients often limit their post-operative participation in sport and leisure activities.

Conclusions

This study has shown the importance of exploring confounding factors, adopting a holistic view of patient recovery beyond surgical outcomes, proposing evidence-based guidance to support and inform healthcare providers with clinical decision-making. This review highlights the paucity and lack of quality of research available, emphasising how under-represented this population is in the research literature.

IMPLICATIONS FOR REHABILITATION

• Patients having undergone LSS often have limited participation in sport and leisure activities.

• Patients can develop range of motion complications, such as flexion contracture or extension lag, which may affect the pattern of gait.

• Clinical consideration should be given to walking ability and gait patterns during the rehabilitation phase to prevent poor functional outcomes during recovery.

• Variation of treatment protocols, outcome measurement and rehabilitative care has been identified as important in predicting the outcomes in recovery from LSS procedures.

Keywords:

• Enhanced recovery after surgery
• limb salvage
• outcome
• process assessment (health care
• sarcoma
• surgical oncology

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

The Authors would also like to acknowledge the international research consortium, Exceed Research Network (ERN), coordinated by the International Non-Government Organisation, Exceed Worldwide, based in Lisburn, Northern Ireland, for providing substantial support to MDH, CO and CM.

Author contributions

NAMD conceptualised the topic and conducted the literature search and analysis of the literature.

CO provided content from a specialist physiotherapy perspective, provided a critical review and helped refine the manuscript for publication.

MDH provided perspective from a health psychology viewpoint and provided critical review prior to submission of the manuscript.

CM provided guidance during the review process, refined and finalised the manuscript for publication.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Double blind policy

The authors have chosen to adhere to the double-blind policy therefore have removed any information which might identify the author’s identity.