Compartmental resection for subfascial extremity soft tissue sarcoma and quality of life in long-term survivors

Abstract

The surgical management of soft tissue sarcoma has changed over the past years, resulting in an interdisciplinary multimodal approach and limb-preserving treatment modalities. From 464 consecutive patients with a soft tissue sarcoma (STS) of an extremity, a compartmental resection was performed in 82 patients, usually for primary subfascial large tumors. Postoperative quality of life was evaluated using the EORTC Score C30. In our study population, 52% of STS was poorly differentiated, 32% moderately, and 16% well differentiated. Survival proved to be dependent on tumor grade and tumor biology, but not on tumor size. The overall survival rate was 81.5%, 71.9%, and 58.3% after 2, 3, and 5 years, respectively. Leiomyosarcoma (39%) and malignant fibrous histiocytoma (42%) are associated with poor 5-year survival rate compared to liposarcoma (82%). Metastases were observed in 33% of T1 and 43% of T2 tumors corresponding to 51% with G3 tumors, 52% with G2 and 23% with G1 tumors. We found a decreased quality of life score in our patients in all dimensions compared to a normal population. Despite the elevated risk of a functional deficit, compartmental resection reduces the risk of local recurrence comparable to the recurrence rates after the most radical surgery limb amputation.

Superficial Soft Tissue Sarcomas of the Extremities and Trunk

“…Our results accentuate the need for a radical surgical approach to the primary tumor; for all subcutaneous tumors a radical resection achieving three-dimensional tumor-free resection margins may be associated with improved freedom of local recurrence [19]. The prognostic influence of initial optimal resection on local resection in spite of initial re-excision was demonstrated in a recent study that supports the demand for treatment of STS in specialized centers [20]. The observation by Rydholm and Gustafson Our multivariate analysis revealed that the size of the primary tumor is the single risk factor of local recurrence.…”

Patient’s quality of life after surgery and radiotherapy for extremity soft tissue sarcoma - a retrospective single-center study over ten years

“…Patients’ QoL (investigated with RAND-36) after hyperthermic isolated limb perfusion for locally advanced extremity soft tissue sarcoma was significantly worse in physical functioning comparing to the healthy Dutch population [8]. Investigations of QoL after compartimental resection for subfascial extremity soft tissue sarcoma (using EORTC Score C30) showed decreased QoL scores in all dimensions, compared to a normal population [31]. Reichardt et al and Coens et al investigated the HRQoL of patients with soft tissue sarcoma and chemotherapy [32, 33].…”

Health‐related quality‐of‐life results from PALETTE: A randomized, double‐blind, phase 3 trial of pazopanib versus placebo in patients with soft tissue sarcoma whose disease has progressed during or after prior chemotherapy—a European Organization for research and treatment of cancer soft tissue and bone sarcoma group global network study (EORTC 62072)

“…Even general information on HRQoL in advanced STS after first‐line treatment is scarce: only 6 randomized trials (this study and 5 phase 2 trials) have been published since 1980 . HRQoL results are more common in extremity STS in patients with early/localized disease . For this population, surgical options and impairment in physical functioning are obviously the dominant issues, as is the lack of patient input in decisions regarding treatment .…”