Enrico Martin

283 General discussion and future perspectives additional argument to consider nerve reconstructions. 36 Based on Chapter 8-11 , surgeons should be encouraged to integrate functional reconstructions at an early stage, considering all available reconstructive techniques and determining an optimal surgical and reconstructive plan based on patient and tumor characteristics. Any patient with localized disease should be eligible and special attention should be paid to patients with extremity or plexus tumors, large and deep-seated tumors, and NF1 patients. In the era of limb salvage surgery, complete recovery of motor and sensory function and no neuropathic pain should be the goal whenever possible. Future perspectives Future studies should be encouraged to multicenter prospectively collect functional outcomes and indications for functional reconstructions in a multidisciplinary sarcoma team with close collaboration between oncological and reconstructive surgeons. Both objective and subjective outcome measures of motor and sensory function as well as pain should be registered at least until one year postoperatively. Trials are very unlikely to arise and the evidence provided in previous literature and this thesis is arguably strong enough to advocate an increase of the use of functional reconstructions and preservation of function in selected cases. However, to further elucidate ideal candidates and choice of reconstructive strategies, more can be learned by prospectively collecting functional outcomes in MPNST and STS. The risk stratification of lesion biology based on imaging proposed earlier can further help in diminishing wide resections and find patients suitable for direct marginal resections. The effect of consequent whoops excisions on oncological and functional outcomes can then be investigated as well. In order to decrease rates of postoperative neuropathic pain in MPNST, studies can already address the prevalence and risk factors for its development in retrospective cohorts. Despite the inherent limitations of its retrospective nature, this information is available in the MONACO study and could be utilized for this purpose as well. Future perspectives of patient-tailored approaches to MPNST With its diverse presentation, complex biology, and varying outcomes, patient-tailored approaches to MPNST treatment are justified. In other STS, recent calculators have been proposed for day-to-day use, including Sarculator and PERSARC for extremity STS. 37,38 However, these calculators may possibly be less applicable for general use in MPNST as, for instance, they do not incorporate NF1 disease nor all possible tumor sites. In Chapter 2-4 we proposed several factors associated with decreased survival in MPNST and subgroups as pediatric and retroperitoneal MPNST. The MONACO study will hopefully aid in creating an online calculator for overall survival and disease- free survival specifically for MPNST patients. Future studies should be encouraged to use the resulting calculator and validate its usefulness. The calculator may help to 12