gms | German Medical Science

Objectives: In surgery for soft tissue sarcoma (STS), smaller tumours may not need additional measures of limb reconstruction following wide resection. On the contrary, large tumours or tumours adjacent to critical structures equally require wide resection and thus modalities of limb reconstruction to cover for defects and to achieve sufficient functional and cosmetic results. While it seems established that deep or large STS come along with unfavourable outcomes, this study aims to investigate whether a wide resection of these unfavourable tumours together with surgical limb reconstruction can compensate the inherent worse prognosis.

Methods: As a single-center retrospective cohort analysis, we evaluated 437 patients who were treated for STS between 1967 and 2006. This included 208 female and 229 male patients with a mean age of 49 years. For comparison of small tumours to large tumours or tumours with relations to vital structures, we subclassified the patient population into two groups. The "resection" group received only resection of the STS, while the "reconstruction" group received resection plus additional reconstruction. The resection group consisted of 296 subjects (68%), the reconstruction group of 141 patients (32%). The reconstruction group was further differentiated into different modes of reconstruction, including endoprosthesis (32 patients), vascular (38 patients), nerve (17 patients), soft tissue (74 patients) and bone reconstruction (20 patients) groups. The mean follow up was 89 months.

Results and Conclusion: Between the resection and reconstruction groups, differences in tumour size (7.2 cm to 8.7 cm, p<0.01) and volume (144 cm3 to 288 cm3, p<0.01) as well as violated surgical margins (14% to 4%, p<0.01) were found. The overall survival (OS) of the resection group was 85%, 61% and 51% at one, five and ten years, compared to 87%, 58% and 46% of the reconstruction group (p=0.80). Regarding subgroups of the reconstruction group, the endoprosthetic reconstruction group showed the worst survival outcomes, with a cumulative survival of 74%, 45% and 35% at one, five and ten years (p=0.05), while the bone reconstruction group showed the best outcome with a cumulative survival of 100%, 70% and 70% at one, five and ten years (p=0.03).

This study showed no differences in survival parameters concerning patients treated with sole resection in comparison to patients with extensive reconstruction after resection, albeit surgical reconstruction came with larger tumours. Although we intuitively might assume that tumours which are located unfavourably or are bigger in size should come with a worse prognosis, a more aggressive surgical approach with awareness of an increased rate of complications might compensate for negative prognostic factors.