What is the role of surgery in the treatment of soft-tissue sarcomas of the extremities?

Updated: Dec 03, 2018
  • Author: Vinod B Shidham, MD, FRCPath; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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Answer

Surgery is the most important component of any treatment plan for a clinically localized primary or recurrent soft-tissue sarcoma. On the basis of the achievable margin, one of the following four types of excisions may be performed:

  • Intracapsular excision and amputation
  • Marginal excision and amputation
  • Wide excisions and amputation
  • Radical excision and amputation

An intracapsular excision or amputation passes within the tumor itself. The tumor inside the pseudocapsule is removed (often piecemeal). Incidence of local recurrence with these types of excisions is virtually 100%; these procedures are performed only in unusual circumstances.

In marginal excisions and amputation, the excision is performed through the pseudocapsule surrounding the tumor. Shelling-out procedures and most excisional biopsies belong to this category. The chance of local recurrence is 20-75%, depending on the nature of the tumor and whether or not radiotherapy is used.

In a wide excision, the tumor is excised with a wide margin of surrounding normal tissue but within the muscular compartment. Without adjuvant therapy, the incidence of local recurrence after wide excision varies but may reach 30%; the rate depends on the selection criteria used and the adequacy of the histologically assessed surgical margin. A wide amputation is performed through the normal tissue proximal to the reactive zone around the tumor but remains within the involved compartment. Limb-sparing procedures belong to this category.

Radical excisions are en-bloc excisions of the tumor along with the entire muscle compartment. Amputation with disarticulation of the joint proximal to the involved compartment is called radical amputation. The risk of local recurrence is lowest with this procedure.


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