Feasibility of limb salvage and survival in soft tissue sarcomas

Abstract

One hundred nine consecutive patients with soft tissue sarcomas were treated in the period 1977 through 1983. Of 85 patients with extremity sarcomas, only 3 patients (4%) were managed with amputation, whereas in the previous decade, 40% of such patients were treated with amputation in our institute. The current 5-year survival rate is 63%; in the previous decade it was 45%. In the current series, for extremity locations, patients with minimum surgical margins of 2 cm or greater and no further local therapy had a 5-year local recurrence rate of 17%, whereas those with minimum surgical margins of less than 2 cm and who were treated with adjuvant postoperative radiation had a local recurrence rate of 7%. In the previous period, the local recurrence rate was 30% after wide resection and 66.6% after local excision. With a combination of modalities, limb salvage can be practiced currently in the majority of patients with extremity soft tissue sarcomas without any adverse effect on recurrence rates and survival.Cancer 57:484-491, 1986.OFT TISSUE SARCOMAS are relatively uncommon tu-S mors; therefore, experience in their management can be expected only in comprehensive cancer centers or other major referral centers. Furthermore, even in cancer centers, when the tumors are classified according to histologic type, the corresponding numbers of patients are small and insufficient for statistical evaluation. Despite distinct differences in their biologic behavior according to their specific histologic features, however, soft tissue sarcomas share common features such as a predilection for the hematogenous route in metastasizing and the common and often exclusive involvement of the lungs as the site of distant spread.' They all originate from tissues derived from primitive mesenchyme. These facts make it both necessary and possible to evaluate soft tissue sarcomas as a group. To make possible a more accurate prognostication for these tumors and to allow a more meaningful comparison of patients between different series, a staging system has been proposed based on the histologic grade and size of the tumor and evidence of bone, nerve, or vessel invasion by the tumor. Accepted for publication August 12, 1985. In the last decade, in addition to the efforts in improving the cure rates for patients afflicted by these tumors, increasing emphasis has been placed on improving the quality of life of the patients. In the past, the rate of amputations for extremity soft tissue sarcomas was 40% to 47%.334 It was well-known that conservative local resection was associated with a prohibitively high rate of local recurrences, in the range of 65% to 90%.3,s In a series by Simon and Enneking of 54 patients with soft tissue sarcomas of the extremities, 46 patients had adequate resection, either by radical compartmental resection or amputation, and had a local recurrence rate of 2%, whereas 8 patients with inadequate resection all had local recurrence. The projected 5-year survival rate in that study was 62?k6

Influence of Local Recurrence on the Prognosis of Soft-Tissue Sarcomas

“…Wide local excision combined with adjuvant radiotherapy, chemotherapy, or both has become standard instead of ablative surgery such as amputation. [1][2][3][4] Unfortunately, inadequate initial surgery of primary tumours is still frequent, before consultation with referral centres. This results in a high incidence of local recurrence, reported as between 50% and 80%.…”

Soft tissue sarcomas in adults

“…The two most common subtypes diagnosed in current series are liposarcoma and malignant fibrous histiocytoma. 3,4 The latter diagnosis was rarely made in the past, but following the clarification of histologic criteria, it has become the most common subtype in some series. Other histologic subtypes are leiomyosarcoma, fibrosarcoma, rhabdomyosarcoma, synovial sarcoma, angiosarcoma, hemangiopericytoma, alveolar soft-part sarcoma, and epithelioid sarcoma.…”

Vascular Management in Rotationplasty

“…However, numerous complications have been reported with this procedure, including nonunion, malunion, local recurrence, compartment syndrome, superficial infection, and deep infection [2,6,9,13,19]. One of the most serious potential complications involves vascular compromise of the reconstructed limb [11, 17, 20-22, 27, 32, 33].…”