Archives of Orthopaedic and Trauma Surgery

, Volume 133, Issue 4, pp 481–486

Planned preservation surgery for soft tissue sarcomas adjacent to critical structures

Authors

    • Department of Orthopaedic SurgeryNagoya University Graduate School of Medicine
  • Yoshihiro Nishida
    • Department of Orthopaedic SurgeryNagoya University Graduate School of Medicine
  • Hiroshi Urakawa
    • Department of Orthopaedic SurgeryNagoya University Graduate School of Medicine
  • Eisuke Arai
    • Department of Orthopaedic SurgeryNagoya University Graduate School of Medicine
  • Eiji Kozawa
    • Department of Orthopaedic SurgeryNagoya University Graduate School of Medicine
  • Naoki Ishiguro
    • Department of Orthopaedic SurgeryNagoya University Graduate School of Medicine
Orthopaedic Surgery

DOI: 10.1007/s00402-013-1690-0

Cite this article as:
Tsukushi, S., Nishida, Y., Urakawa, H. et al. Arch Orthop Trauma Surg (2013) 133: 481. doi:10.1007/s00402-013-1690-0
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Abstract

Background

Whether to preserve or sacrifice critical structures (bone, major vessels and major nerves) adjacent to soft tissue sarcomas is still controversial. Referring to characteristic imaging and intraoperative findings, we perform planned preservation surgery for these critical structures. The aim of this study was to investigate the clinical outcome of soft tissue sarcomas adjacent to critical structures and to validate this procedure.

Methods

Of 202 cases of soft tissue sarcomas surgically treated at our department of orthopedic surgery from 2004 to 2010, 57 cases (28 %) whose tumors were adjacent to the critical structures were studied. There were 36 men and 21 women. In 32 cases critical structures were preserved, and in 25 resected together with the tumor. The oncological outcome and histological surgical margin were analyzed.

Results

The overall survival and local recurrence-free survival rates at 5 years were 75.9 and 83.2 %. In 26 of the 32 (81 %) preserved cases histologically the surgical margin was negative, and in 17 (53 %) radiotherapy could be avoided. Neither overall survival (p = 0.9669) nor local recurrence-free survival (p = 0.7819) differed significantly between two groups.

Conclusions

When soft tissue sarcomas are located adjacent to bone or major vessels, by meticulously detaching the periosteum or neurovascular sheath referring to characteristic imaging and intraoperative findings, a histologically negative surgical margin can be achieved in the majority, allowing avoidance of postoperative radiotherapy. Planned preservation surgery provided no significant adverse effect on survival or local recurrence rates, validating this procedure.

Keywords

Soft tissue sarcomaCritical structureLimb salvageSurgical marginHistological assessment

Copyright information

© Springer-Verlag Berlin Heidelberg 2013