Evaluation of Surgical Quality in Extremity Soft Tissue Sarcomas

Objective: The exact treatment of extremity soft tissue sarcomas is extended surgical excision with this chemotherapy and/or radiotherapy. Despite surgical resection with a negative margin and adjuvant radiotherapy, extremity soft tissue sarcomas tend to local recurrence. This study assessed surgical quality by examining short- and long-term local recurrence ratios with the prognostic factors affecting local tumor control. Materials and Methods: A retrospective examination was made of 130 patients treated for a diagnosis of soft tissue sarcoma localized in an extremity. The parameters affecting local recurrence were evaluated, such as the surgical margin, sarcoma size, depth, histotype, grade, the adjuvant/neoadjuvant treatment protocol, and unplanned surgery. Results: The mean follow-up period of the patients was 44 months (range,20-70 months). Of the 118 patients who underwent extremity-sparing surgery, R0 resection was applied to 96, and R1 resection to 32. In the 20-month follow-up period, the local recurrence ratio was 19% in surgical border-negative patients and 28% in surgical border-positive patients. The local recurrence rates during the 3-year follow-up period were 24% in patients undergoing R0 surgical treatment only, 21% in those with R0 surgery+radiotherapy(RT), 34% following re-resection in those with R1, and 38% in those with R1 applied with RT only. Conclusion: The local recurrence-free period is the most important marker of surgical margin quality. To provide optimal surgical quality, sarcoma cases should be discussed in multidisciplinary tumor panels and treatments must be personalized according to the clinical and demographic characteristics of the patient and the histopathological type of the sarcoma. The treatment of extremity soft tissue sarcomas must be performed by a specialized team with good knowledge of the physiopathology of sarcomas for optimal surgical margin and local control. Primary care physician training should be planned beyond direct patient referral to the sarcoma center for early diagnosis and treatment and to avoid unplanned surgery.