Table 4.

Functional outcome following sarcoma resection.

Paper	Patient population	Comparison	Outcome measure	Impact on functional outcome
Davis et al. [58]	Lower extremity STS	Function of patients with limb salvage	MSTS 87 MSTS 93 TESS SF-36	Large tumor size: Lower extremity MSTS 1987, MSTS 1993, TESS Motor nerve resection (femoral, obturator, sciatic, peroneal, and posterior tibial nerves): Lower MSTS 1987, MSTS 1993, TESS Postoperative complications” Lower MSTS 1987 High-grade tumors: Lower MSTS 1993 and TESS Bone resection: Lower MSTS 1993
Davis et al. [32]	Extremity STS	Pre- vs. Postoperative radiotherapy	MSTS TESS SF-36	Postoperative radiotherapy: Improved MSTS, TESS, and SF-36 at 6 weeks postoperative only SF-36 compared to normative data: Lower for both treatment arms across all time points Wound complications: Lower MSTS at 6 weeks, 3, 6, 12, and 24 months Increased disability compared to baseline TESS Large tumor size (>10 cm): Lower MSTS scores at 6, 12, and 24 months Motor nerve resection: Lower MSTS scores Previous unplanned excision: Lower TESS score at 3, 6, 12, and 24 months
Davis et al. [31]	Extremity STS	Late morbidity: Pre- (50 Gy) vs. Postoperative (66 Gy) radiotherapy	MSTS TESS	Subcutaneous fibrosis: Decreased MSTS and TESS Joint stiffness: Decreased MSTS and TESS Extremity lymphedema: Decreased MSTS and TESS Pre- vs. Postoperative radiotherapy: No difference in MSTS or TESS Trend toward greater fibrosis with postoperative radiotherapy
Payne et al. [63]	Upper extremity STS with flap coverage	Pedicled vs. Free flap for wound coverage	MSTS 87 MSTS 93 TESS	Pedicled vs. free flaps: Decreased MSTS 87 from pre- to postoperative in patients with either pedicled or free flap Decreased MSTS 93 for free flaps No difference in TESS between groups Patients rated their function better compared to the actual rated impairment
Davis et al. [66]	Lower extremity limb salvage sarcoma patients	Relationship of symptoms to function during 1st year postoperative	Stiffness Fatigue Pain Weakness Limited range of motion TESS	Stiffness: Plateaus at 3 months Remains constant over the year Fatigue: Plateaus at 3 months Remains constant over the year Pain: Constant for 3 months then declines over study Weakness: Constant for 3 months then declines over study Limited Range of Motion: Constant decline over study TESS: Presence of pain, stiffness, weakness, and limited range of motion were predictors of worse outcome
Gerrand et al. [59]	Lower Extremity Limb Salvage Sarcoma patients	Sarcoma location and functional outcome: Groin/Femoral triangle Buttock Anterior thigh Medial thigh Posterior thigh Popliteal fossa Posterior calf Anterolateral leg Foot and ankle	MSTS 93 TESS	Deep vs. superficial: Superficial tumors have improved MSTS and TESS scores Superficial tumors: No decrease in MSTS or TESS from to pre- to postoperative Deep Tumors: No difference in MSTS or TESS based on tumor location Groin/Femoral triangle tumors: Increased pain based on the MSTS compared to other anatomic areas Decreased ability to sit, put on socks, getting in and out of bath, bending to pick up items More likely to have a limp or gait handicap Buttock/Posterior thigh: Decreased ability to sit
Ghert et al. [46]	Lower extremity limb salvage sarcoma patients	Vascular reconstruction and functional outcome: Femoral Iliofemoral Popliteal Tibial/Peroneal	TESS	Vascular reconstruction: More likely to need a muscle flap, have a wound complication, sustain a deep vein thrombosis (DVT), suffer from edema of the limb, and require an amputation No difference in the postoperative TESS
Jones et al. [45]	Lower extremity limb salvage sarcoma patients	Nerve resection and functional outcome: Femoral Sciatic Comparison of femoral nerve resection and location: Gender-matched large anterior thigh All large anterior thigh	MSTS 87 MSTS 93 TESS	Femoral nerve resection: No difference in MSTS 87, MSTS 93, or TESS between patients with sciatic nerve resection, gender-matched large anterior thigh tumors, or all patients with large anterior thigh tumors Long-term risk of falling which could lead to fracture
Pradhan et al. [67]	Patients with STS of the adductor compartment	Outcome of treatment of adductor compartment STS	TESS	Impact on TESS: Wound complications and high-grade tumors had lower TESS Timing of radiotherapy (pre- vs. postoperative) had no effect on TESS Need for a muscle flap; had no effect on TESS
Riad et al. [62]	Patients with radiation induced STS	Outcome of treatment in patients with a radiation-induced STS compared to patients with a sporadic STS	MSTS 87 TESS	Radiation induced vs. Sporadic STS: No difference in the MSTS 87 or TESS

MSTS 87 = Musculoskeletal Tumor Society Functional Rating System 1987, a measure of impairment; MSTS 93 = Musculoskeletal Tumor Society Functional Rating System 1993, a measure of impairment; TESS = Toronto Extremity Sarcoma Salvage Score, a measure of functional disability; SF-36 = 36-Item Short Form Health Survey, a quality of life measure.