Critical study of resection margins in adult soft-tissue sarcoma surgery

Abstract

IV.

Neoadjuvant and adjuvant chemotherapy combined with anatomical resection of feline injection‐site sarcoma: results in 21 cats

“…Extensive surgery is associated with increased patient morbidity, that is difficult to justify if the patient ultimately dies from metastatic disease or experiences rates of local tumour recurrence similar to that achieved by a more conservative resection. In human studies on soft tissue sarcoma management, the challenge of balancing local surgical aggression with the need for effective local tumour control, patient morbidity and the risk of tumour metastasis is the focus of considerable debate . Several authors have determined that while the development of metastatic disease is not influenced by the extensiveness of local surgery, incomplete tumour resection is consistently associated with poor overall survival .…”

“…How wide the excision margin needs to be for effective control of the soft tissue sarcoma is the topic of considerable debate in both human and veterinary literature . Several human studies have suggested that the incidence of recurrence for soft tissue sarcoma is similar in patients with margins of less than 1 mm and greater than 1 mm, and recurrence can still occur in patients reported with clean margins . The cause of recurrence in patients with histologically clean margins is unclear.…”

“…Some authors have described sarcoma cells disrupting the pseudocapsule in high‐grade lesions, with small isolated nodules (skip metastases) developing outside the main tumour margin . Several authors describe isolated tumour nodules located some distance from the main tumour . It is suggested that tumour recurrence may arise from these isolated microscopic nodules if they are not removed as part of the en bloc resection.…”

High-grade myxofibrosarcoma of the abdominal wall

“…Negative tumour margins lower local recurrence rates and improve long-term survival 14 15. Indeed, the wider these resection margins the better, especially with poorly differentiated tumours, which may have satellite lesions and a greater predisposition to local recurrence 16. In the event of tumour invasion or compression of an important adjacent structure, the surgeon must consider the risks and benefits of either partial resection of the adjacent structure or careful dissection around the tumour with a higher likelihood of leaving a positive resection margin 13.…”

“…This may occur because of high-grade histology,16 because the tumour may not be encapsulated but possess finger-like projections into the surrounding tissue23 or because of a high likelihood of positive resection margins. If local recurrence is likely, a temporary method of abdominal wall reconstruction may be used.…”