Enrico Martin

244 Chapter 10 Overall p=0.011 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties Never Generally not Sometimes Always Consider reconstruction if motor deficit anticipated A Overall p=0.001 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties Never Generally not Sometimes Always Consider reconstruction if sensory deficit anticipated B Overall p=0.263 0 2 4 6 Surgical Oncology Neurosurgery Plastic Surgery Other Specialties Life Expectancy in Years Life expectancy before considering reconstruction C Overall p=0.075 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties Direct Direct, unless Rx 3 months 6−12 months No reconstructions Ideal timing of reconstruction D Figure 4 Considerations for performing functional reconstructions in MPNST. A) Distribution per subspecialty considering a functional reconstruction when a motor deficit is anticipated B) Distribution per subspecialty considering a functional reconstruction when a sensory deficit is anticipated C) Mean life expectancy before considering a functional reconstruction per subspe- cialty D) Ideal timing of functional reconstruction per subspecialty, Rx = radiotherapy. Discussion Practice variation exists both within as well as between surgical subspecialties treating MPNSTs. Although neuropathic pain, motor deficits, and sensory deficits are common postoperative morbidities among all surgical specialties, little consensus is present on ideal balancing of functional and oncological outcomes. Highest surgical caseloads are among surgical oncologists and neurosurgeons, yet these subspecialties are least likely to consider functional reconstructions in MPNST patients. Conversely, there is little difference in opinion between subspecialties on relative contraindications.