gms | German Medical Science

Objectives/Interrogation: The aim of this study was to evaluate the surgical management and outcomes of patients with acral (peripheral extremity hand or foot) soft tissue sarcomas.

Methods and Patients: We identified 63 patients with acral soft tissue sarcomas who presented to a tertiary referral sarcoma service (27 hands and 36 feet). Mean age was 49 (35 males and 28 females). The commonest sarcoma subtypes were epithelioid in the hand (8 patients) and synovial in the foot (11 patients).

Results and Conclusions: In 41 patients (65%) the tumour size was less than 5cm in its largest dimension (median size 3cm). 27 patients (43%) were diagnosed after inadvertent excision prior to their referral to the specialist sarcoma unit. After biopsy and staging, primary surgical intervention at the sarcoma unit was excision and limb salvage in 43 (68%), partial (digit or ray) amputation in fourteen (22%) and more proximal amputation in six (10%). At final follow up, local recurrence had been treated by one partial amputation and six amputations, resulting in a partial amputation rate of 24%, and the proximal amputation rate to 19%.

The rate of local recurrence was 19% and the 5 year survival was 82%. Patients who underwent inadvertent excision demonstrated no statistically significant difference in survival or local recurrence, but underwent a higher rate of amputation (p=0.008). Large tumour size (>5cm) was associated with lower survival (p=0.04) and a higher risk of local recurrence (p=0.009).

The majority of acral soft tissue sarcomas are smaller than 5cm at presentation, indicating that whilst size can be a useful prognostic factor, it should not be used as a diagnostic threshold for referral. Increased tumour size is associated with a higher rate of local recurrence and reduced survival. Sarcoma excision with limb preservation does not result in an increased risk of local recurrence.