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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2010

01-08-2010 | Bone and Soft Tissue Sarcomas

Soft Tissue Sarcoma of Extremities: The Prognostic Significance of Adequate Surgical Margins in Primary Operation and Reoperation After Recurrence

Authors: Chun-Yu Liu, MD, Chueh-Chuan Yen, MD, PhD, Wei-Ming Chen, MD, Tain-Hsiung Chen, MD, Paul Chih-Hsueh Chen, MD, PhD, Hung-Ta Hondar Wu, MD, Cheng-Ying Shiau, MD, Yu-Chung Wu, MD, Chien-Lin Liu, MD, Cheng-Hwai Tzeng, MD

Published in: Annals of Surgical Oncology | Issue 8/2010

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Abstract

Background

Adult soft tissue sarcomas (STS) of extremities are prone to recurrence despite apparently complete resection. This study aimed to explore the impact of clinicopathological factors on outcome and to define an “oncological safe margin” in these patients.

Methods

A total of 181 patients with extremity STS were enrolled in a retrospective study. The prognostic influence of margin status and other clinicopathological characteristics on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-specific survival (DSS), were examined by univariate and multivariate analyses. The influence of surgical margins on postrecurrence survival (PRS) of patients undergoing reoperation for relapsed lesions during follow-up was analyzed by the Kaplan–Meier method.

Results

Surgical margin width <10 mm and deep tumor depth at primary operation were consistently statistically significant independent adverse factors for LRFS, DMFS, and DSS. Patients with liposarcoma or low grade tumors had significantly higher chances of achieving adequate margins. Of 83 patients who experienced recurrence or metastasis, 53 (63.9%) received reoperation for their relapsed lesions. Patients who achieved microscopically negative margins (R0) at reoperation had significantly better PRS than those who did not (P < 0.007). Overall, patients with no recurrences had the best DSS, while relapsed patients receiving R0 reoperation had better DSS than those receiving either non-R0 reoperation or no reoperation at all.

Conclusion

Surgical margins prognostically influence survival in both patients undergoing primary surgery and those undergoing reoperation for relapse of extremity STS. In primary surgery, the chance of achieving adequate margin may reflect the underlying aggressiveness of tumors.
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Metadata
Title
Soft Tissue Sarcoma of Extremities: The Prognostic Significance of Adequate Surgical Margins in Primary Operation and Reoperation After Recurrence
Authors
Chun-Yu Liu, MD
Chueh-Chuan Yen, MD, PhD
Wei-Ming Chen, MD
Tain-Hsiung Chen, MD
Paul Chih-Hsueh Chen, MD, PhD
Hung-Ta Hondar Wu, MD
Cheng-Ying Shiau, MD
Yu-Chung Wu, MD
Chien-Lin Liu, MD
Cheng-Hwai Tzeng, MD
Publication date
01-08-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 8/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-0997-0

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