Surgical Outcome of Soft Tissue Sarcomas of the Adductor Compartment

Abstract

Purpose. To review outcomes and complications of 25 consecutive patients with soft tissue sarcomas in the adductor compartment. Methods. Records of 11 men and 14 women aged 20 to 83 (mean, 56) years who underwent resection for soft tissue sarcomas in the adductor compartment were reviewed. Two of the patients had undergone inadequate resection of the tumour elsewhere. No patient had metastases. 20 and 2 patients underwent neo-adjuvant and postoperative radiotherapy, respectively. The interval between radiotherapy and surgery was at least 3 weeks. No neo-adjuvant chemotherapy was given. 24 patients underwent limb salvage surgery and one had external hemipelvectomy. 21 patients had direct wound closure; in 4 a microsurgical free flap was used. Results. The overall survival rate was 81% and 72% at 3 and 5 years, respectively, and remained unchanged until the end of follow-up. Four patients died from 2009;17(3):284-7 2009;17(3):284-7 pulmonary metastases and one died from liver metastases. One patient had local recurrence, and 7 (26%) developed major complications. Five patients underwent revision surgery. Conclusion. Good survival and local control rates can be achieved in patients with soft tissue sarcomas in the adductor compartment using limb salvage and radiotherapy.

Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review

“…Adjuvant radiotherapy was administered to some patients, either preoperatively (1-100%) or postoperatively (6-88%), in 24 of the included studies. Preoperative radiotherapy, which may allow for the use of smaller field sizes and lower radiation doses and have lower long-term morbidity than postoperative radiotherapy (Pisters et al, 2007), seemed to be the standard of care at an Australian study centre (Choong et al, 2003;Hui et al, 2006;Rudiger et al, 2009;Miki et al, 2010), despite the potential for acute postoperative wound complications (Hui et al, 2006;Rudiger et al, 2009). Although the use of adjuvant chemotherapy may help local control, its marginal, if any, survival benefit (Pervaiz et al, 2008;Woll et al, 2012) has generally restricted its use to treatment of metastatic disease (Casali et al, 2010;National Comprehensive Cancer Network, 2012).…”

“…Only 13 studies specified whether STS was primary or recurrent [8 primary (Dickinson et al, 2006;Hui et al, 2006;Wu et al, 2006;An et al, 2007;Kim et al, 2008a;Ng and Tan, 2009;Wang et al, 2009;Liu et al, 2010); 5 primary or recurrent (Hsieh et al, 2003;Kiatisevi et al, 2006;Moncrieff et al, 2008;Miki et al, 2010;Cho et al, 2011)]. Patients had local disease in 15 studies (Choong et al, 2003;Campbell et al, 2004;Hsu et al, 2004;Dickinson et al, 2006;Hui et al, 2006;An et al, 2007;Kim et al, 2007;2008c;Pervaiz et al, 2008;Rudiger et al, 2009;Wang et al, 2009;Liu et al, 2010;Cho et al, 2011;Han et al, 2011), and local or metastatic disease in 7 studies (Wu et al, 2006;Chan et al, 2008;Moncrieff et al, 2008;Koh et al, 2009;Jun et al, 2010;Park et al, 2010;Lee et al, 2011). The remaining 10 studies did not specify whether disease was local or metastatic.…”

“…All patients were treated with surgery, among whom only 9 patients from 3 studies had amputations. In 1 study (Rudiger et al, 2009), major complications arising from surgery (infection, wound breakdown necessitating debridement and re-closure, giant haematoma, severe permanent lymphoedema, intra-operative catheterisation for femoral artery spasm) were reported for 7 (26%) patients (80% of all patients had received preoperative radiotherapy). Few patients (3%, 1 study) had preoperative chemotherapy, whereas most patients (80% and 100%) in 2 studies had preoperative radiotherapy (Table 4).…”

A sub-Saharan African experience in the surgical management of soft tissue sarcomas in an oncology unit in: a retrospective cohort study

“…Local recurrence may be a reflection of tumor biology and the acknowledged pivotal role of neoadjuvant radiotherapy in reducing local recurrence [39]. Our post- operative morbidity/mortality rate and duration of hospital admission compared favorably with other, more advanced centers [11, 40, 41], despite not matching their operative volume.…”

Complex reconstruction of the lower extremity following sarcoma resection: a literature review

“…Primarily, malignant sarcomas of the femur are generally challenging to treat because radical resection of the tumor often requires simultaneous resection and reconstruction of the major femoral vessels. Tumor proximity to critical neurovascular structures is particularly of concern in the adductor compartment, where outcomes are generally poor, with high local recurrence rate, high complication rates and short long-term survival [12] . The first report of reconstruction of major vessels was by Fortner et al [13] for the treatment of seven patients with sarcoma involving the iliac and femoral vessels.…”