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Surgical resection of primary soft tissue sarcoma of the extremities

Author
Mark C Gebhardt, MD
Section Editors
Raphael E Pollock, MD
Robert Maki, MD, PhD
Deputy Editors
Kathryn A Collins, MD, PhD, FACS
Diane MF Savarese, MD

INTRODUCTION

Sarcomas are uncommon malignant tumors that arise from skeletal and extraskeletal connective tissues, including the peripheral nervous system. They can arise from mesenchymal tissue at any body site.

The surgical management of primary soft tissue sarcomas (STSs) of the extremities will be reviewed here. The clinical features, diagnosis, classification, and staging of primary STS of the extremity and radiation-associated sarcomas, as well as an overview of multimodality therapy as used for STS of the extremities and chest wall, are discussed separately. (See "Clinical presentation, histopathology, diagnostic evaluation, and staging of soft tissue sarcoma" and "Radiation-associated sarcomas" and "Local treatment for primary soft tissue sarcoma of the extremities and chest wall".)

Because of their rarity and the frequent need for multimodality treatment, surgical management of STS should ideally be carried out in a center with expertise in the treatment of sarcomas. The surgical expertise of dedicated subspecialists improves clinical outcomes. In one study that examined outcomes of 375 patients with STS of the extremities, local recurrence rates were 1.3-fold higher in those referred only after definitive surgery and were 2.4-fold higher for patients not referred at any time [1]. (See "Clinical presentation, histopathology, diagnostic evaluation, and staging of soft tissue sarcoma" and "Local treatment for primary soft tissue sarcoma of the extremities and chest wall" and "Systemic treatment of metastatic soft tissue sarcoma".)

TREATMENT OVERVIEW

The goals of treating extremity soft tissue sarcomas (STSs) are to minimize local recurrence, perioperative morbidity, and mortality and to maximize function and long-term survival. To achieve these goals, radiation therapy (RT) combined with wide surgical resection is recommended for most patients with high-grade primary extremity STS, with some exceptions [2]. The role of chemotherapy continues to be debated.

Adjuvant radiation is often used to aid with local control when it is predicted that adequate margins will be difficult to achieve, usually around major nerves and blood vessels. The particular adjunctive therapy (chemotherapy and/or RT) chosen is based upon the size and grade of the tumor but also upon institutional expertise, experience, and preferences. (See 'Adjunctive medical therapies' below and "Local treatment for primary soft tissue sarcoma of the extremities and chest wall", section on 'Benefit of RT' and "Local treatment for primary soft tissue sarcoma of the extremities and chest wall", section on 'Initial chemoradiotherapy for large high-grade STS'.)

                                    

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Literature review current through: Nov 2016. | This topic last updated: Thu Nov 10 00:00:00 GMT 2016.
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