Soft Tissue Sarcomas of the Extremities: Surgical Margins Can Be Close as Long as the Resected Tumor Has No Ink on It

Abstract

In the present retrospective analysis of 643 patients with primary soft issue sarcomas of the extremities, surgical margins could be identified as independent predictors of local recurrence-free, disease-specific, and metastasis-free survival. Given the diminished outcome of patients left with positive margins, surgical efforts should aim to achieve microscopically negative margins whenever feasible. It is noteworthy that only the quality of surgical margins, but not the negative margin width attained, had an influence on the prognosis. Our findings suggest that surgical margins can be close as long as the resected tumor has no ink on it.

Histologic margins and the residual tumour classification scheme: Is it time to use a validated scheme in human oncology to standardise margin assessment in veterinary oncology?

“…Histologic margins are commonly described as being incomplete or complete, with incomplete histologic margins being defined as neoplastic cells extending to the edge of the surgical resection margins or 'tumour on ink'. [1][2][3][4][5][6] However, in some studies, an incomplete histologic excision has been arbitrarily defined as a HTFM ≤1 mm, [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] ≤2 mm 23 or ≤5 mm. 24 The assessment of histologic margins is further complicated by the common use of 'close' or 'narrow' histologic margins in veterinary oncology.…”

The role of radiation therapy and margin width in localized soft‐tissue sarcoma: Analysis from the US Sarcoma Collaborative

“…For example, in a cohort of 387 patients who underwent wide local excision with RT, no difference in survival, local, or distant recurrence was noted with any width of quantitative margin (≤1 mm [positive], >1‐≤5 mm, and ≥5 mm) . Other investigations evaluating similar margins in a series of 643 patients and 117 patients had the same conclusions. However, distant disease was higher in patients with positive (≤1 mm) or close (1‐10 mm) margins, despite no difference in LR .…”

“…The definition of an appropriate resection margin remains controversial and is still debated. Several studies have examined margin width classification and LR with varying lower (≤1 mm) and upper (>4 cm) margin thresholds, as well as interval spacing between margin groups . Resection recommendations have previously been proposed to help guide decision making.…”

“…Several studies have examined margin width classification and LR with varying lower (≤1 mm) and upper (>4 cm) margin thresholds, as well as interval spacing between margin groups. [19][20][21][22][23][24][25][26][47][48][49] Resection recommendations have previously been proposed to help guide decision making. The 2018 NCCN guidelines for extremity STS recommends a surgical goal of "functional limb preservation, if possible, within the realm of an appropriate oncologic resection," without specifying a margin width.…”

“…Patients were stratified by quantitative margin status and defined into three categories: positive margin (tumor on ink), ≤1 mm margin (no tumor on ink), and >1 mm margin. Margins were stratified based upon previous investigations . Crude local control incidence was assessed and compared amongst treatment groups (no RT, preoperative RT, or postoperative RT).…”