The role of surgery in soft tissue sarcoma: Can we improve outcome and function towards sporting activities?

Reinhard Windhager,Gerhard M Hobusch

doi:10.1007/s12254-020-00583-3

Reinhard Windhager, Gerhard M Hobusch

Open Access

https://doi.org/10.1007/s12254-020-00583-3

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Journal: Memo	Publication Date: Mar 9, 2020
Citations: 2	License type: CC BY 4.0

Affiliation: Medical University of Vienna

Abstract

SummaryLimb-sparing surgery with pre- or postoperative irradiation has evolved as the standard of care for local tumor control of soft tissue sarcoma while ablative procedures are applied in selected cases only. Adequate excision of sarcoma is prerequisite to guarantee local tumor control. While excision with wide margins has been educated in the past, tumor excision with closer margins has shown to provide similar local tumor control. Beside this oncological aspect, type of surgery and reconstruction impact the functional outcome after sarcoma excision in the extremities, which adds to quality of life for the patients. Satisfactory results have been shown by different scoring systems; however, more recent studies focus on high level activities like sports to define the efficacy of different procedures. This review focuses on recent developments within these two topics.

Highlights

Soft tissue sarcomas (STS) are rare tumors of mesenchymal origin and account for roughly 1% of all adult malignancies [1]
The algorithm of diagnosis and treatment should always start with MRI as the method of choice followed by staging with chest CT or PET-CT after the diagnosis of sarcoma has been established (Fig. 1)
While amputation was the standard of care in the treatment of soft tissue sarcomas in the very beginning, this treatment has been substituted by limb-sparing surgery after evidence has been gained about the safety and effectiveness of this combined

Summary

Background

Soft tissue sarcomas (STS) are rare tumors of mesenchymal origin and account for roughly 1% of all adult malignancies [1]. While amputation was the standard of care in the treatment of soft tissue sarcomas in the very beginning, this treatment has been substituted by limb-sparing surgery after evidence has been gained about the safety and effectiveness of this combined. Limb-sparing surgery with simple local excision of soft tissue sarcoma was associated with a higher local recurrence rate compared to amputation if not combined with radiotherapy [13,14,15,16]. Over the last three decades limb-sparing surgery with radiation therapy has become the standard of care in the treatment of localized soft tissue sarcomas, whereas amputation is carried out in less than 10%

Surgical margins

Functional evaluation

Findings

Preop RTX