Surgical Resection of Sarcomas
Excerpts from ESUN Articles
Surgery is the cornerstone of treatment for all soft tissue sarcomas. The goal of surgery is to eradicate all disease in the affected area. For extremity sarcomas, surgical options fall into two categories: limb-sparing and amputation. Historically, soft tissue sarcomas were treated with amputation. As our understanding of sarcoma has evolved, so has the treatment. Several studies have demonstrated no difference in patient survival with amputation versus limb-salvage (Refs. 46 and 47). In a randomized clinical trial run by the National Cancer Institute (ref. 40), there was no difference in overall survival for patients with soft tissue sarcoma that had amputation (70%) versus those that had amputation (71%). Currently at least 90% of tumors are now removed using limb-sparing surgery, meaning that the tumor is removed while saving the extremity.
Limb sparing surgery should only be performed if the surgeon is confident that the tumor can be completely removed and that the remaining extremity provides reasonable function. Obviously balancing oncologic and functional outcomes is a very complex and subjective undertaking. It is very important that the patient and treating surgeon discuss the expectations of all options preoperatively. Reconstruction following tumor resection is sometimes necessary depending on the size of the tumor and what structures need to be sacrificed. For example, a bone or joint may need to be reconstructed or soft tissue flaps may be needed for wound coverage (Morris, ESUN V2N2).
Margins
Once a tumor has been removed, the pathologist analyzes the entire specimen to confirm the tumor’s grade and margins. The term margin refers to the outermost edges of a resection specimen. A negative margin indicates that there are no tumor cells on the periphery of the tumor implying that a complete resection was achieved. A positive margin means that tumor cells were found on the periphery of the resection specimen which implies there is likely residual microscopic disease. Obviously one hopes to achieve negative margins at the time of surgery. Unfortunately it is not always possible to accomplish this. When possible, wide and radical procedures are attempted in order to obtain negative margins (Morris, ESUN V2N2).
| Intralesional | Partial removal of the tumor |
| Marginal | Through the reactive zone; may leave residual microscopic disease |
| Wide | Entire tumor removed with a cuff of normal tissue |
| Radical | Entire compartment containing the tumor removed |
Function after Surgery
It is important to note that even with limb-sparing procedures, functional deficits may be encountered. These may vary significantly depending on the size and location of the individual tumor, and are due to the removal of tissues associated with the tumor (i.e. muscles, tendons, nerves, etc). Reconstruction of post resection deficits can in some instances be performed to minimize these effects (Gebhardt and Buecker, ESUN V1N5).
Copyright © 2004 and 2005 Liddy Shriver Sarcoma Initiative.