Tumor Bed Resection

Abstract

Soft tissue sarcomas (STSs) are often mistaken as benign tumors and treated surgically. For superficial masses below 3 cm, excisional biopsy can be considered. However, in addition to these, the design and implementation of resections, which have no detailed clinical information, no histological diagnosis or no negative resection (R0) of the surgical margin under the microscope that is based on the anatomical location of the local tumor, are all unplanned resections. Such unplanned resections or excisional biopsies often enucleate the tumors along the margin of the tumor as what would be done to benign tumors. This leads to residual tumor in up to 65% of the cases, which is one of the important reasons for tumor recurrence. For the patients having a second resection, their survival periods are affected by the local tumor residues. The local control of the tumors is the primary endpoint in evaluating the quality of the surgical treatment for STSs. Eilber, et al. [3] reported that early recurrence of high-grade sarcoma predicted poor prognosis. Although, radiotherapy may decrease the recurrence rate of the patients with positive surgical margin under the microscope, for patients with macroscopic residual (R2) resection, the 5-year control rate is still lower than 50% with radical radiotherapy. And with the increase of the radiotherapy dose, the incidence of complications also increases. Harati et al. [6] recently reported that further tumor bed resection after unplanned resection may still achieve good local control. Therefore, tumor bed resection should be necessary if the indications are satisfied.