Surgical Margins and Handling of Soft-Tissue Sarcoma in Extremities: A Clinical Practice Guideline

Kandel, Rita A.; Coakley, N.; Werier, Joel; Engel, Jay; Ghert, Michelle; Verma, Shailendra

doi:10.3747/co.20.1308

Cited by 97 publications

(86 citation statements)

References 33 publications

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“…18 Inconsistent reporting of outcomes impedes comparative research, particularly for rare diseases. An ideal margin classification system would be prognostic for LR and would be reproducible, to facilitate communication among clinicians and researchers.…”

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confidence: 99%

Analysis of Margin Classification Systems for Assessing the Risk of Local Recurrence After Soft Tissue Sarcoma Resection

Gundle

Kafchinski

Gupta

et al. 2018

JCO

168

110

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To compare the ability of margin classification systems to determine local recurrence (LR) risk after soft tissue sarcoma (STS) resection. MethodsTwo thousand two hundred seventeen patients with nonmetastatic extremity and truncal STS treated with surgical resection and multidisciplinary consideration of perioperative radiotherapy were retrospectively reviewed. Margins were coded by residual tumor (R) classification (in which microscopic tumor at inked margin defines R1), the R+1mm classification (in which microscopic tumor within 1 mm of ink defines R1), and the Toronto Margin Context Classification (TMCC; in which positive margins are separated into planned close but positive at critical structures, positive after whoops re-excision, and inadvertent positive margins). Multivariate competing risk regression models were created. ResultsBy R classification, LR rates at 10-year follow-up were 8%, 21%, and 44% in R0, R1, and R2, respectively. R+1mm classification resulted in increased R1 margins (726 v 278, P , .001), but led to decreased LR for R1 margins without changing R0 LR; for R0, the 10-year LR rate was 8% (range, 7% to 10%); for R1, the 10-year LR rate was 12% (10% to 15%) . The TMCC also showed various LR rates among its tiers (P , .001). LR rates for positive margins on critical structures were not different from R0 at 10 years (11% v 8%, P = .18), whereas inadvertent positive margins had high LR (5-year, 28% [95% CI, 19% to 37%]; 10-year, 35% [95% CI, 25% to 46%]; P , .001). ConclusionThe R classification identified three distinct risk levels for LR in STS. An R+1mm classification reduced LR differences between R1 and R0, suggesting that a negative but , 1-mm margin may be adequate with multidisciplinary treatment. The TMCC provides additional stratification of positive margins that may aid in surgical planning and patient education.J Clin Oncol 36.

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confidence: 99%

Analysis of Margin Classification Systems for Assessing the Risk of Local Recurrence After Soft Tissue Sarcoma Resection

Gundle

Kafchinski

Gupta

et al. 2018

JCO

168

110

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“…30 Nevertheless, the Association of Directors of Anatomical and Surgical Pathology recommends that any margin macroscopically more than 5 cm is believed to be clear. 31,32 In our patients, the lesion was removed as widely or radically as possible. The margin was at least 7 cm above or below the limit of increased activity of the bone scan.…”

Section: Discussionmentioning

confidence: 99%

En bloc resection and prosthesis implantation to treat malignant fibrous histiocytoma of the humerus

Sun¹,

Zhang²,

Zheng³

2017

Adv Clin Exp Med

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“…Surgical margins of 1 to 2 cm considered as free for all types of skin cancers in our study. The surgical margins depend on the type of cutaneous cancers: ≥1 cm for SCC, 0.5 -2 cm for melanoma [7] and 2 cm or more for sarcoma [12]. Mohs micrographic surgery is an outpatient procedure that maximizes surgical margin evaluation while minimizing the amount of tissue that must be excised [13] [14].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Surgical Treatment of Skin Cancer at Surgical Oncology Unit of Donka, Conakry University Hospital

Traoré¹,

Lamah²

2017

JCT

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Aim: The main aim of this study was to evaluate outcomes after surgical treatment of skin cancer. Methods: This retrospective cohort study concerned 46 patients who presented 43 skin cancers lesions surgically treated at surgical oncology unit, Conakry University Hospital. There were 29 (61.7%) squamous cell carcinoma, 12 (25.5%) melanoma, 4 (8.5%) sarcomas and 1 (2.1%) porocarcinoma. Surgical indications and prognosis factors were analyzed. Results: Surgical treatment included simple excision in 2 cases (3.8%), wide excision in 38 cases (71.7%) and amputation/disarticulation in 13 cases (24.5%). Inguinal lymph node dissection was performed in 16 patients (34.3%). Postoperative complications were wound suppuration (5 cases), lower limb lymphedema (4 cases), seroma (2 cases) and skin flap necrosis (1 case). Surgical margins were free in 28 (60.9%) patients, infiltrated in 3 patients (6.5%) and unspecified in 15 patients (32.6%). The median follow-up after surgery was 29 months. During the follow-up, 13 patients (28.3%) had a relapse. The relapse was influenced by surgical margins (p = 0.012) and iterative resection (p = 0.04). Overall survival was 65.2%. Factors related to survival in univariate analysis were: iterative resection (p = 0.008), fungated tumor (p = 0.037), the status of surgical margins (p = 0.002) and the occurrence of relapse (p = 0.0000). In multivariate analysis, the status of surgical margins was the only independent prognostic factor. Conclusion: The prognosis after surgical treatment of cutaneous cancers depends on the resection margins.

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Surgical Margins and Handling of Soft-Tissue Sarcoma in Extremities: A Clinical Practice Guideline

Cited by 97 publications

References 33 publications

Analysis of Margin Classification Systems for Assessing the Risk of Local Recurrence After Soft Tissue Sarcoma Resection

Analysis of Margin Classification Systems for Assessing the Risk of Local Recurrence After Soft Tissue Sarcoma Resection

En bloc resection and prosthesis implantation to treat malignant fibrous histiocytoma of the humerus

Outcomes of Surgical Treatment of Skin Cancer at Surgical Oncology Unit of Donka, Conakry University Hospital

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