EVALUATION OF SURGICAL QUALITY IN EXTREMITY SOFT TISSUE SARCOMAS

İlker Dedeli, Bedii Şafak Güngör, AHMET FEVZİ KEKEÇ , HALİL SEZGİN SEMİZ, Şefik Murat Arıkan, Yaman Karakoç

  • Bedii Şafak Güngör: Ankara Onkoloji Eğitim ve Araştırma Hastanesi Tıp Fakültesi
  • AHMET FEVZİ KEKEÇ: NECMETTİN ERBAKAN ÜNİVERSİTESİ
  • HALİL SEZGİN SEMİZ: SAĞLIK BAKANLIĞI
  • Year : 2026
  • Vol : 42
  • Issue : 1
  •  Page : 8-14
Objective: The exact treatment of extremity soft tissue sarcomas is extended surgical excision with this chemotherapy and/or radiotherapy. Despite surgical resection
with a negative margin and adjuvant radiotherapy, extremity soft tissue sarcomas tend to local recurrence. This study assessed surgical quality by examining shortand
long-term local recurrence ratios with the prognostic factors affecting local tumor control.
Materials and Methods: A retrospective examination was made of 130 patients treated for a diagnosis of soft tissue sarcoma localized in an extremity. The parameters
affecting local recurrence were evaluated, such as the surgical margin, sarcoma size, depth, histotype, grade, the adjuvant/neoadjuvant treatment protocol, and
unplanned surgery.
Results: The mean follow-up period of the patients was 44 months (range,20-70 months). Of the 118 patients who underwent extremity-sparing surgery, R0 resection
was applied to 96, and R1 resection to 32. In the 20-month follow-up period, the local recurrence ratio was 19% in surgical border-negative patients and 28% in surgical
border-positive patients. The local recurrence rates during the 3-year follow-up period were 24% in patients undergoing R0 surgical treatment only, 21% in those with
R0 surgery+radiotherapy(RT), 34% following re-resection in those with R1, and 38% in those with R1 applied with RT only.
Conclusion: The local recurrence-free period is the most important marker of surgical margin quality. To provide optimal surgical quality, sarcoma cases should
be discussed in multidisciplinary tumor panels and treatments must be personalized according to the clinical and demographic characteristics of the patient and
the histopathological type of the sarcoma. The treatment of extremity soft tissue sarcomas must be performed by a specialized team with good knowledge of the
physiopathology of sarcomas for optimal surgical margin and local control. Primary care physician training should be planned beyond direct patient referral to the
sarcoma center for early diagnosis and treatment and to avoid unplanned surgery.
Cite this Article As : Dedeli I, Gungor BS, Kekec AF, Semiz HS, Arikan SM, Karakoc Y. Evalutaion of Surgical Quality in Extremity Soft Tissue Sarcomas. Selcuk Med J 2026;42(1): 8-14

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Conflict of interest : The authors declare that they have no conflict of interest.
This article is published under the CC BY-NC 4.0 license.
Selcuk Medical Journal
2026, Vol. 42 (1)
ISSN: 1017-6616
E-ISSN: 2149-8059
Received : , Accepted : , Published Online :

References

  1. 1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics. CA Kanser J Klin. 2021;71(1):7-33. doi: 10.3322/caac.21654.
  2. 2. Burningham Z, Hashibe M, Spector L, et al.The epidemiology of sarcoma. Clin. Sarcoma Res. 2012;2:14. doi: 10.1186/2045-3329-2-14.
  3. 3. Choi JH, Ro JY. The 2020 WHO Classification of Tumors of Soft Tissue: Selected Changes and New Entities. Adv. Anat. Pathol. 2021;28:44-58. doi: 10.1097/PAP.0000000000000284.
  4. 4. Dangoor A, Seddon B, Gerrand C, et al. UK guidelines for the management of soft tissue sarcomas .Clin Sarcoma Res. 2016;6:20. doi: 10.1186/s13569-016-0060-4.
  5. 5. Abarca T, Gao Y, Monga V, et al. Improved survival for extremity soft tissue sarcoma treated in high-volume facilities. J Surg Oncol. 2018;117(7):1479-86. doi: 10.1002/jso.25052.
  6. 6. Kandel R, Coakley N, Werier J, et al. Sarcoma Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based Care. Surgical margins and handling of soft-tissue sarcoma in extremities: A clinical practice guideline. Curr. Oncol. 2013;20:247-54. doi: 10.3747/co.20.1308.
  7. 7. Byerly S, Chopra S, Nassif NA, et al. The role of margins in extremity soft tissue sarcoma. J. Surg. Oncol. 2016;113:333-38. doi: 10.1002/jso.24112.
  8. 8. Casali PG, Abecassis N, Aro HT, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Onkol. 2018;29:268-69. doi: 10.1093/annonc/mdy321.jpg
  9. 9. AJCC Manual for Staging of Cancer, 3rd edition. JB Lippincott; 1988.
  10. 10. Clark MA, Fisher C, Judson I, et al. Soft-tissue sarcomas in adults. N. Engl. J. Med. 2005;353:701-11. doi: 10.1056/NEJMra041866.
  11. 11. Bonvalot S, Levy A, Terrier P, et al. Primary Extremity Soft Tissue Sarcomas: Does Local Control Impact Survival? Ann Surg Oncol. 2017;24(1):194-201. doi: 10.1245/s10434-016-5462-2.
  12. 12. Zagars GK, Ballo MT, Pisters PW, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer. 2003;97(10):2530-43. doi:10.1002/cncr.11365
  13. 13. Kawaguchi N, Ahmed AR, Matsumoto S, et al.The concept of curative margin in surgery for bone and soft tissue sarcoma. Clin. Orthop. Relat. Res. 2004;165-72. doi: 10.1097/00003086-200402000-00027.
  14. 14. Fujiwara T, Kaneuchi Y, Tsuda Y, Stevenson J, Parry M, Jeys L. et al. Low-grade soft-tissue sarcomas: What is an adequate margin for local disease control? Surg Oncol. 2020;35:303-08. doi: 10.1016/j.suronc.2020.08.022.
  15. 15. Azzarelli A. Surgery in soft tissue sarcomas. Eur J Cancer. 1993;29A(4):618-23. doi: 10.1016/s0959-8049(05)80165-0.
  16. 16. McKee MD, Liu DF, Brooks JJ, et al. The prognostic significance of margin width for extremity and trunk sarcoma. J Surg Oncol. 2004;85(2):68-76. doi: 10.1002/jso.20009.
  17. 17. Dickinson IC, Whitwell DJ, Battistuta D, et al. Surgical margin and its influence on survival in soft tissue sarcoma. ANZ J Surg. 2006;76(3):104-09. doi: 10.1111/j.1445-2197.2006.03615.x.
  18. 18. Cates MM, Cates JMM. Surgical resection margin classifications for high-grade pleomorphic soft tissue sarcomas of the extremity or trunk: definitions of adequate resection margins and recommendations for sampling margins from primary resection specimens. Mod Pathol. 2019;32(10):1421-33. doi: 10.1038/s41379-019-0278-9.
  19. 19. 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. doi: 10.1200/JCO.2005.04.160.
  20. 20. Stojadinovic A, Leung DH, Hoos A, et al. Analysis of the prognostic significance of microscopic margins in 2,084 localized primary adult soft tissue sarcomas. Ann Surg. 2002;235(3):424-34. doi: 10.1097/00000658-200203000-00015.
  21. 21. Stefanovski PD, Bidoli E, De Paoli A, et al. Prognostic factors in soft tissue sarcomas: a study of 395 patients. Eur J Surg Oncol. 2002;28(2):153-64. doi: 10.1053/ejso.2001.1242.
  22. 22. Kainhofer V, Smolle MA, Szkandera J, et al. The width of resection margins influences local recurrence in soft tissue sarcoma patients. Eur J Surg Oncol. 2016;42(6):899-906. doi: 10.1016/j.ejso.2016.03.026.
  23. 23. Bilgeri A, Klein A, Lindner LH, et al. The Effect of Resection Margin on Local Recurrence and Survival in High Grade Soft Tissue Sarcoma of the Extremities: How Far Is Far Enough? Cancers (Basel). 2020;12(9):2560. doi: 10.3390/cancers12092560.
  24. 24. Sinha S, Peach AH. Diagnosis and management of soft tissue sarcoma. BMJ. 2010;341:c7170. doi: 10.1136/bmj.c7170.
  25. 25. Pitcher ME, Fish S, Thomas JM. Management of soft tissue sarcoma. Br J Surg. 1994(8):1136-39. doi: 10.1002/bjs.1800810817.
  26. 26. Pitcher ME, Ramanathan RC, Fish S, et al. Outcome of treatment for limb and limb girdle sarcomas at the Royal Marsden Hospital. Eur J Surg Oncol. 2000;26(6):548-51. doi: 10.1053/ejso.2000.0944.
  27. 27. Coindre JM, Terrier P, Guillou L, et al. Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas: a study of 1240 patients from the French Federation of Cancer Centers Sarcoma Group. Cancer. 2001;91(10):1914-26. doi: 10.1002/1097-0142(20010515)91:103.0.co;2-3.
  28. 28. Trovik CS, Bauer HC, Alvegård TA, et al. Surgical margins, local recurrence and metastasis in soft tissue sarcomas: 559 surgically-treated patients from the Scandinavian Sarcoma Group Register. Eur J Cancer. 2000;36(6):710-16. doi: 10.1016/s0959-8049(99)00287-7.
  29. 29. Rydholm A, Rööser B. Surgical margins for soft-tissue sarcoma. J Bone Joint Surg Am. 1987;69(7):1074-78.
  30. 30. Simon MA, Enneking WF. The management of soft-tissue sarcomas of the extremities. J Bone Joint Surg Am. 1976;58(3):317-27.
  31. 31. Spinnato P, Clinca R, Vara G, et al. MRI Features as Prognostic Factors in Myxofibrosarcoma: Proposal of MRI Grading System. Acad Radiol. 2021;28(11):1524-29. doi: 10.1016/j.acra.2020.08.018.
  32. 32. Harati K, Daigeler A, Goertz O, et al. Primary and Secondary Soft Tissue Angiosarcomas: Prognostic Significance of Surgical Margins in 43 Patients. Anticancer Res. 2016;36(8):4321-28.
  33. 33. Dadrass F, Gusho C, Yang F, et al. A clinicopathologic examination of myxofibrosarcoma. Do surgical margins significantly affect local recurrence rates in this infiltrative sarcoma subtype? J Surg Oncol. 2021;123(2):489-96. doi: 10.1002/jso.26277.
  34. 34. Bianchi G, Sambri A, Cammelli S, et al. Impact of residual disease after "unplanned excision" of primary localized adult soft tissue sarcoma of the extremities: evaluation of 452 cases at a single Institution. Musculoskelet Surg. 2017;101(3):243-48. doi: 10.1007/s12306-017-0475-y.
  35. 35. Lewis JJ, Leung D, Espat J, et al. Effect of reresection in extremity soft tissue sarcoma. Ann Surg. 2000;231(5):655-63. doi: 10.1097/00000658-200005000-00005.
  36. 36. Pisters PW, Harrison LB, Leung DH, et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14(3):859-68. doi: 10.1200/JCO.1996.14.3.859.
  37. 37. Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197-203. doi: 10.1200/JCO.1998.16.1.197.
  38. 38. DeLaney TF, Kepka L, Goldberg SI, et al. Radiation therapy for control of soft tissue sarcomas resected with possitive margins. Int J Radiat Oncol Biol Phys. 2007;67:1460-69.
  39. 39. Khanfir K, Alzieu L, Terrier P, et al. Does adjuvant radiation therapy increase loco-regional control after optimal resection of soft-tissue sarcoma of the extremities? Eur J Cancer. 2003;39(13):1872-80. doi: 10.1016/s0959-8049(03)00426-x.
  40. 40. Baldini EH, Goldberg J, Jenner C, et al. Long-term outcomes after function-sparing surgery without radiotherapy for soft tissue sarcoma of the extremities and trunk. J Clin Oncol. 1999;17(10):3252-59. doi: 10.1200/JCO.1999.17.10.3252.
  41. 41. Sadoski C, Suit HD, Rosenberg A, et al. Preoperative radiation, surgical margins, and local control of extremity sarcomas of soft tissues. J Surg Oncol. 1993;52(4):223-30. doi: 10.1002/jso.2930520405.
  42. 42. Ahmad R, Jacobson A, Hornicek F, et al. The Width of the Surgical Margin Does Not Influence Outcomes in Extremity and Truncal Soft Tissue Sarcoma Treated With Radiotherapy. Oncologist. 2016;21(10):1269-76. doi: 10.1634/theoncologist.2015-0534.