The Classic: The Principles and Technique of Resection of Soft Parts for Sarcoma

Bowden, Lemuel; Booher, Robert J.; Peabody, Terrance D.; Mindell, Eugene R.

doi:10.1097/01.blo.0000141673.52701.4f

Cited by 21 publications

(27 citation statements)

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“…Even in cases when resection margins can be proven tumor cell free by the pathologist, local recurrence can be caused be a single remaining clonogen cell that is not detectable by the pathologist. Compartmental resection in fact reduces the risk of local recurrence to 10-20% [28,41], comparable to the recurrence rates after limb amputation. Additionally, the use of postoperative radiotherapy can further improve local control and should nowadays be applied to the majority of patients even when the tumor has been excised with a very wide negative margin.…”

Section: Discussionmentioning

confidence: 69%

“…Most surgeons accept the postulate of Bowen published in 1958 that the anatomic localization of the tumor is a much greater importance than histology or size [28]. However, the opinion of Zornig et al [29], who demands compartmental resection because due to the deep localization subfascial tumors are much more diffi cult to resect and the risk of intraoperative tumor injury is relatively high in a limited resection, contrasts with Steinau et al [30] who believes that compartmental resection is not mandatory because satellite metastases within the muscle compartment are rare and do not justify the higher morbidity of such resections.…”

Section: Discussionmentioning

confidence: 97%

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Compartmental resection for subfascial extremity soft tissue sarcoma and quality of life in long-term survivors

Peiper

Matthaei

Bölke

et al. 2011

Wien Klin Wochenschr

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The surgical management of soft tissue sarcoma has changed over the past years, resulting in an interdisciplinary multimodal approach and limb-preserving treatment modalities. From 464 consecutive patients with a soft tissue sarcoma (STS) of an extremity, a compartmental resection was performed in 82 patients, usually for primary subfascial large tumors. Postoperative quality of life was evaluated using the EORTC Score C30. In our study population, 52% of STS was poorly differentiated, 32% moderately, and 16% well differentiated. Survival proved to be dependent on tumor grade and tumor biology, but not on tumor size. The overall survival rate was 81.5%, 71.9%, and 58.3% after 2, 3, and 5 years, respectively. Leiomyosarcoma (39%) and malignant fibrous histiocytoma (42%) are associated with poor 5-year survival rate compared to liposarcoma (82%). Metastases were observed in 33% of T1 and 43% of T2 tumors corresponding to 51% with G3 tumors, 52% with G2 and 23% with G1 tumors. We found a decreased quality of life score in our patients in all dimensions compared to a normal population. Despite the elevated risk of a functional deficit, compartmental resection reduces the risk of local recurrence comparable to the recurrence rates after the most radical surgery limb amputation.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 97%

Compartmental resection for subfascial extremity soft tissue sarcoma and quality of life in long-term survivors

Peiper

Matthaei

Bölke

et al. 2011

Wien Klin Wochenschr

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“…Since recognizing the cause of local recurrence as being residual tumour cells from the pseudocapsule of softtissue sarcomas 34 , wide local resection with clear surgical resection margins has become the goal. Striking a balance in achieving this aim, together with preservation of limb function, remains the central challenge in the management of extremity soft-tissue sarcoma.…”

Section: Discussionmentioning

confidence: 99%

Major amputation for soft-tissue sarcoma

Clark

Thomas

2002

British Journal of Surgery

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Background: Advances in oncological practice have reduced the number of major amputations performed for soft-tissue sarcoma, but this remains a valuable, if infrequent, option for both curative and palliative indications.Methods: A review of patients and case-notes was carried out from the prospective sarcoma database at the Royal Marsden Hospital.Results: Over a 10-year interval, 40 major amputations (18 forequarter, 17 hindquarter and five through hip) were performed, predominantly for disease recurring after previous limb-conserving surgery (31 of 40). A wide variety of soft-tissue sarcoma subtypes was seen; they were often large (more than 10 cm; 18 of 40) or multifocal (six), usually high grade (25), and frequently proximal or involving neurovascular structures such that limb salvage was precluded. Median range age of the patients was 59 (17-87) years. The operative 30-day mortality rate was zero. Hospital stay was a median of 10·5 days for forequarter amputation, and 19 days for hindquarter and through-hip amputation. Local recurrence occurred in ten patients, six of whom had concurrent distant metastases. Twenty-seven patients were alive (20 disease free) at a median follow-up of 12 months, nine of whom were alive without evidence of disease beyond 2 years. Ten patients died after a median of 7·5 months; three survived more than 2 years. Conclusion:Major amputation is a useful procedure in carefully selected patients with soft-tissue sarcoma.

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“…The conduct of surgery for sarcoma of any site of origin is dictated by a growth pattern in which centrifugal expansion occurs with infi ltration along tissue planes formed by fascia, muscle, and bone. Compressed tissue surrounding the enlarging mass forms a pseudocapsule that is penetrated by malignant cells extending a considerable distance from gross tumor [34]. Therefore, excision along involved planes leaves extracapsular microscopic disease in situ at the circumference of the resection margin, leading to the possibility of multicentric recurrence, and such extracapsular enucleation of sarcoma carries a local recurrence rate of up to 90% [35].…”

Section: Surgerymentioning

confidence: 99%

Sarcomas of the head and neck region

Shellenberger¹

2009

Curr Oncol Rep

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Sarcomas of the head and neck are a heterogeneous group of rare malignancies with highly variable clinical presentation, pathologic classification, and biologic behavior. Managing patients with sarcoma is a formidable challenge for surgical, medical, and radiation oncologists. This article reviews current approaches in patient evaluation, staging, prognosis, and treatment, with emphasis on prolonged survival and quality of life.

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The Classic: The Principles and Technique of Resection of Soft Parts for Sarcoma

Cited by 21 publications

References 0 publications

Compartmental resection for subfascial extremity soft tissue sarcoma and quality of life in long-term survivors

Compartmental resection for subfascial extremity soft tissue sarcoma and quality of life in long-term survivors

Major amputation for soft-tissue sarcoma

Sarcomas of the head and neck region

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