Evaluating limb salvage with sciatic nerve sacrifice: oncologic outcome, functional recovery, and patient satisfaction: a case series.

Introduction: To evaluate the oncologic and functional outcomes in a retrospective case series of 14 patients undergoing sciatic nerve resection as part of limb-sparing surgery for soft tissue sarcomas involving the gluteal region and posterior thigh. Methods: This retrospective study analyzed 14 patients treated between 2019 and 2022, each undergoing sciatic nerve resection to achieve oncologic margins. Tumor characteristics were reviewed, including histology, grade, size, and surgical margins. Functional outcomes were assessed using Musculoskeletal Tumor Society (MSTS) scores and additional metrics such as ambulation status, device dependence, and patient satisfaction. Results: The median tumor size was 12 cm, with nine high-grade tumors identified. An R0 margin was obtained in 93% (13/14) of patients. At a median follow-up of 40 months, local recurrence-free survival was 86% (12/14 patients). Five patients (36%) developed distant metastases; the overall survival rate at 3 years was 71% (10/14 patients). Functionally, 9 patients (64%) regained ambulatory function using orthotic devices, achieving a median MSTS score of 21/30 (70%, indicating moderate disability). Chronic neuropathic pain occurred in 43% (6/14) of patients, and 71% (10/14) experienced chronic leg edema. Nonetheless, all patients reported high satisfaction with limb preservation. Conclusion: Sciatic nerve resection during limb-sparing surgery provides effective local tumor control and allows for limb preservation despite notable functional impairment. Patient satisfaction remains high, supporting this approach as a potentially oncologically safe and acceptable alternative to amputation, which warrants further validation in larger studies.