Surgical strategies and the use of functional reconstructions after resection of MPNST: An international survey on surgeons’ perspective

Background: 

Malignant peripheral nerve sheath tumors (MPNST) are aggressive and possibly morbid sarcomas because of their tissue of origin. However, postoperative functional status of MPNST patients has been understudied. Reconstructions may play a role in restoring lost function, but are still infrequently carried out. This study investigated how surgical considerations and the use of functional reconstructions differed among surgeons treating MPNST. 

Methods: 

This survey was distributed among members of multiple surgical societies. Survey responses were analyzed overall and between surgical subspecialties (surgical oncology/neurosurgery/plastic surgery/other). 

Results: 

A total of 30 surgical oncologists, 30 neurosurgeons, 85 plastic surgeons, and 29 ‘others’ filled out the survey. Surgical oncologists had the highest case load (p < 0.001). Functional status was usually considered preoperatively among all subspecialties (65.1%); 42.2% never considered performing less extensive resections to preserve function. Neuropathic pain and motor deficits are seen in 40.9 ± 22.9% and 36.7 ± 25.5% respectively. Functional reconstructions for motor and sensory deficits were more commonly considered by plastic surgeons and ‘others’. Relative contraindications for reconstructions did not differ between subspecialties (p > 0.05). Most surgeons would reconstruct directly or directly unless radiotherapy would be administered (62.7%). On average, surgeons would consider functional reconstructions when estimated survival is 3.0 ± 2.0 years. 

Conclusions: 

Surgical treatment of MPNSTs differs slightly among subspecialties. Neuropathic pain, motor deficits, and sensory deficits are commonly acknowledged postoperative morbidities. Functional reconstructions are varyingly considered by surgeons. Surgical oncologists and neurosurgeons treat most patients, yet may be least likely to consider functional reconstructions. A multidisciplinary surgical and reconstructive approach may be beneficial in MPNSTs.