The role of surgical margins in atypical Lipomatous Tumours of the extremities

Abstract

BackgroundAtypical lipomatous tumours (ALT) are common adipocytic tumours. Due to their large size and deep-seated location, wide resection might result in severe functional deficits. The question which margins should be aimed is hence discussed controversially.MethodsForty consecutive patients underwent limb-sparing resections. Margins were defined as R0 (wide resection), R1 (marginal resection) or R2 if tumour was left. All patients were followed for evidence of local recurrence or remote metastases. Overall and recurrence-free survival was calculated.ResultsThe mean age at the time of surgery was 61.9 years. The mean tumour diameter was 17 cm with no patient having metastatic disease. In 8 cases a wide (R0) resection, in 31 cases a marginal (R1) and in one patient a R2-resection was performed. The median follow-up time was 40 months. Four patients died due to causes that were not tumour-related. 3 (7.5%) patients (all R1) developed local recurrences. Two of our 3 recurrences in this series occurred in 6 already recurring cases. We observed no dedifferentiation of tumours and no metastatic disease.ConclusionsALT represents a comparatively common diagnosis in large deep-seated lesions of the extremities, especially in patients over 60 years. Marginal resection shows an acceptable rate of local recurrence. The risk of dedifferentiation as proven also in a metaanalysis of the English literature of the last 30 years is close to 1%, metastatic disease is exceedingly rare.

Low Recurrence Rate and Risk of Distant Metastases following Marginal Surgery of Intramuscular Lipoma and Atypical Lipomatous Tumors of the Extremities and Trunk Wall

“…Studies concerning ALT recurrence rates are more often reported in the literature, and as with IML these studies have also shown great variance, ranging from 7.5-22.6% [8][9][10][11][12]. Only a few of these studies calculate a proper LRFS (89-95%) after 5 years [11,12], and only 1 study also calculated a 10-year LRFS of 82% [11], which is in good agreement with our ALT findings. The variance in the reported recurrence rates across the literature might in part be explained by the follow-up regimens used.…”

Distribution of intramuscular giant lipomas in the functional compartments of the forearm: a report of 12 cases

“…Based on typically large size and deep-seated location of the ALTs, wide resection might result in severe functional deficits. Therefore, debate about what type of margins (marginal or wide resection) should be aimed for and whether adjuvant radiotherapy might reduce the risk of local recurrence is still ongoing [34,35].…”

Indikation zur prä-, post- und intraoperativen Strahlentherapie von Liposarkomen des Erwachsenenalters

“…der lokalen Kontrolle für eine additive RT zeigen (5-Jahres-LRFS [LRFS: lokalrezidivfreies Überleben] 98 vs. 80 %), dieser bezog sich laut Subgruppenanalyse aber lediglich auf Patienten nach R1-Resektionen [42]. Eine Literaturanalyse von Rauh et al [43] fand eine gepoolte Lokalrezidivrate von 7 % nach R0-Resektion sowie von 17 % nach R1-Resektionen. Der Anteil von Dedifferenzierungen in den Rezidiven betrug lediglich 14 % [43].…”

“…Eine Literaturanalyse von Rauh et al [43] fand eine gepoolte Lokalrezidivrate von 7 % nach R0-Resektion sowie von 17 % nach R1-Resektionen. Der Anteil von Dedifferenzierungen in den Rezidiven betrug lediglich 14 % [43]. Da die meisten Lokalrezidive chirurgisch suffizient behandelt werden können und nur selten einen dedifferenzierten Anteil enthalten, muss die Indikation zur additiven RT daher selbst nach R1-Resektion eines reinen ALT streng gestellt werden [41,44].…”