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

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgment

The authors thank Ms. Yang Ya-Wen for her excellent assistance in statistical analysis and graph editing.

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Authors and Affiliations

  1. Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chun-Yu Liu MD, Chueh-Chuan Yen MD, PhD & Cheng-Hwai Tzeng MD

  2. National Yang-Ming University School of Medicine, Taipei, Taiwan

    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

  3. Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan

    Wei-Ming Chen MD, Tain-Hsiung Chen MD & Chien-Lin Liu MD

  4. Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan

    Paul Chih-Hsueh Chen MD, PhD

  5. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Hung-Ta Hondar Wu MD

  6. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan

    Cheng-Ying Shiau MD

  7. Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Yu-Chung Wu MD

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  1. Chun-Yu Liu MD
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  2. Chueh-Chuan Yen MD, PhD
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  5. Paul Chih-Hsueh Chen MD, PhD
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  9. Chien-Lin Liu MD
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Corresponding author

Correspondence to Chueh-Chuan Yen MD, PhD.

Additional information

CY Liu and CC Yen contributed equally. The authors report no conflict of interest.

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Liu, CY., Yen, CC., Chen, WM. et al. Soft Tissue Sarcoma of Extremities: The Prognostic Significance of Adequate Surgical Margins in Primary Operation and Reoperation After Recurrence. Ann Surg Oncol 17, 2102–2111 (2010). https://doi.org/10.1245/s10434-010-0997-0

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  • DOI: https://doi.org/10.1245/s10434-010-0997-0

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