Skip to main content

Volume-Outcome Relationship in Surgery of Soft Tissue Sarcomas

  • Chapter
  • First Online:
Volume-Outcome Relationship in Oncological Surgery

Part of the book series: Updates in Surgery ((UPDATESSURG))

  • 221 Accesses

Abstract

Soft tissue sarcomas (STS) are rare malignancies, accounting for 1% of all tumors. The most common site of origin is the extremities (50%), followed by the retroperitoneum (20%), the viscera (15%), the superficial trunk (10%) and the head and neck (5%). Local recurrence is more common among low-grade tumors, while high-grade STS tend to spread distantly. Optimal surgery, with en-bloc resection and clear margins is the only potential curative treatment of localized STS, but it should be tailored to the specific histology and be part of a multidisciplinary management of the disease. A multidisciplinary approach is the goal in all cases of STS. Treatment strategies for all patients must be the result of the consensus of the multidisciplinary team including surgical oncologists, pathologists, radiologists, radiation therapists, and medical oncologists. Given the complexity of the disease and the heterogeneity of the various presentations, it is necessary that the management of sarcoma patients is centralized to referral centers and/or within reference networks that share multidisciplinary expertise. These centers should treat a high number of patients annually and be involved in ongoing clinical trials that allow for the best tailored treatment for each specific case.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Casali PG, Abecassis N, Bauer S, et al. Soft tissue and visceral sarcomas: ESMO–EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv51–67.

    Article  CAS  Google Scholar 

  2. Gundle KR, Kafchinski L, Gupta S, et al. Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection. J Clin Oncol. 2018;36(7):704–9.

    Article  Google Scholar 

  3. Gronchi A, Casali PG, Mariani L, et al. Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: a series of patients treated at a single institution. J Clin Oncol. 2005;23(1):96–104.

    Article  CAS  Google Scholar 

  4. Gronchi A, Lo Vullo S, Colombo C, et al. Extremity soft tissue sarcoma in a series of patients treated at a single institution. The local control directly impacts survival. Ann Surg. 2010;251(3):506–11.

    Article  Google Scholar 

  5. Gronchi A, Verderio P, De Paoli A, et al. Quality of surgery and neoadjuvant combined therapy in the ISG-GEIS trial on soft tissue sarcomas of limbs and trunk wall. Ann Oncol. 2013;24(3):817–23.

    Article  CAS  Google Scholar 

  6. Dingley B, Fiore M, Gronchi A. Personalizing surgical margins in retroperitoneal sarcomas: an update. Expert Rev Anticancer Ther. 2019;19(7):613–31.

    Article  CAS  Google Scholar 

  7. Antritsch E, Beishon M, Bielack S, et al. ECCO essential requirements for quality cancer care: soft tissue sarcoma in adults and bone sarcoma. A critical review. Crit Rev Oncol Hematol. 2017;110:94–105.

    Article  Google Scholar 

  8. Bonvalot S, Gronchi A, Le Pechoux C, et al. STRASS (EORTC 62092): a phase III randomized study of preoperative radiotherapy plus surgery versus surgery alone for patients with retroperitoneal sarcoma. J Clin Oncol. 2019;37(15 Suppl):11001. https://doi.org/10.1200/JCO.2019.37.15_suppl.11001.

    Article  Google Scholar 

  9. Derbel O, Heudel PE, Cropet C, et al. Survival impact of centralization and clinical guidelines for soft tissue sarcoma (a prospective and exhaustive population-based cohort). PLoS One. 2017;12(2):e0158406. https://doi.org/10.1371/journal.pone.0158406.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Blay JY, Honoré C, Stoeckle E, et al. Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Ann Oncol. 2019;30(7):1143–53.

    Article  Google Scholar 

  11. Blay JY, Bonvalot S, Gouin F, et al. Criteria for reference centers for sarcomas: volume but also long-term multidisciplinary organisation. Ann Oncol. 2019;30(12):2008–9.

    Article  Google Scholar 

  12. Kalaiselvan R, Malik AK, Rao R, et al. Impact of centralization of services on outcomes in a rare tumour: retroperitoneal sarcomas. Eur J Surg Oncol. 2019;45(2):249–53.

    Article  CAS  Google Scholar 

  13. Bonvalot S, Gaignard E, Stoeckle E, et al. Survival benefit of the surgical management of retroperitoneal sarcoma in a reference center: a nationwide study of the French Sarcoma Group from the NetSarc database. Ann Surg Oncol. 2019;26(7):2286–93.

    Article  CAS  Google Scholar 

  14. Villano AM, Zeymo A, McDermott J, et al. Regionalization of retroperitoneal sarcoma surgery to high-volume hospitals: missed opportunities for outcome improvement. J Oncol Pract. 2019;15(3):e247–61.

    Article  Google Scholar 

  15. Keung EZ, Chiang YJ, Cormier JN, et al. Treatment at low-volume hospitals is associated with reduced short-term and long-term outcomes for patients with retroperitoneal sarcoma. Cancer. 2018;124(23):4495–503.

    Article  Google Scholar 

  16. Villano AM, Zeymo A, Chan KS, et al. Identifying the minimum volume threshold for retroperitoneal soft tissue sarcoma resection: merging national data with consensus expert opinion. J Am Coll Surg. 2020;230(1):151–60.e2.

    Article  Google Scholar 

  17. Raut CP, Bonvalot S, Gronchi A. A call to action: why sarcoma surgery needs to be centralized. Cancer. 2018;124(23):4452–4.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alessandro Gronchi .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Spolverato, G., Quagliuolo, V., Gronchi, A. (2021). Volume-Outcome Relationship in Surgery of Soft Tissue Sarcomas. In: Montorsi, M. (eds) Volume-Outcome Relationship in Oncological Surgery. Updates in Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-51806-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-51806-6_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-51805-9

  • Online ISBN: 978-3-030-51806-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics