Surgical margin and efficacy evaluation of barrier resection for soft tissue sarcoma of extremities in 72 cases

doi:10.19401/j.cnki.1007-3639.2024.03.007

Abstract

Abstract:

Background and purpose: Limbs soft tissue sarcoma (STS) is a common malignant tumor, and surgical resection is the main treatment method for it. The concept of barrier made us realize the blocking effect of natural barrier on STS, and we aimed to search for tissues that can act as barrier, and to perform complete resection of surgical margins around the tissue barrier. This study aimed to investigate the feasibility, safety and prognosis of barrier resection in the treatment of limbs STS. Methods: From December 2013 to September 2016, data of 72 patients who underwent barrier resection of STS of extremities in department of oncosurgery, Minhang Branch, Fudan University Shanghai Cancer Center were retrospectively analyzed, and the resection margin was sampled. All 72 patients underwent preoperative magnetic resonance imaging (MRI) or computed tomography (CT) design, and the physiological barrier or at least 3 cm distance was found outward from the anatomical location of the tumor. And en bloc excision was performed outside this barrier or at a distance of 3 cm. The influence of postoperative pathological margin, musculoskeletal tumor society (MSTS) score and postoperative complications on the patients were analyzed. The 1- and 3-year locoregional recurrence-free survival (LRFS) rates and sarcoma-specific survival (SSS) rates were evaluated, and the influencing factors were analyzed. This study was approved by the Ethics Committee of Fudan University Shanghai Cancer Center (number: 1212117-12&1212117-12-1301). Results: All patients had negative margins. The 1- and 3-year LRFS rates were 98.2% and 93.3%, respectively. The 1- and 3-year SSS rates were 98.4% and 94.2%, respectively. The mean MSTS scores were 28.3 preoperatively and 25.5 postoperatively. Surgical complications were grade 1 to 2 in 20 cases and grade 3 in 1 case, and there were no grade 4 to 5 complications. Conclusion: Based on the combination of clinical, imaging and pathology data, barrier resection, including tumor resection and functional reconstruction, can be applied to the surgical treatment of STS, with good feasibility and safety, reliable margin and satisfactory local control.

Key words: Soft tissue sarcoma, Barrier, Resection margin, Limb salvage surgery

CLC Number:

R738.6

QU Guolun, ZHANG Ruming, CHEN Yong, QU Xinglong, ZHANG Hongqiang, WANG Hongbo, WANG Kangwei, PENG Shuai. Surgical margin and efficacy evaluation of barrier resection for soft tissue sarcoma of extremities in 72 cases[J]. China Oncology, 2024, 34(3): 293-298.

Figures/Tables 4

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Characteristic	Case n (%)
Gender
Male	41 (56.9)
Female	31 (43.1)
Site
Thigh	32 (44.5)
Lower leg and distal end	17 (23.6)
Upper arm	8 (11.1)
Forearm and distal end	15 (20.8)
Case condition
Primary	12 (16.7)
Relapse	39 (54.2)
Tumor bed	21 (29.1)
Histological subtype
Pleomorphic undifferentiated sarcoma	18 (25.0)
Myxofibrosarcoma	15 (20.8)
Fibrosarcoma	7 (9.7)
Liposarcoma	7 (9.7)
Synovial sarcoma	5 (7.0)
Others	20 (27.8)
The length of the tumor (n=54)/cm
≤5	22 (30.6)
>5	32 (44.4)
Preoperative chemotherapy
Yes	2 (2.8)
No	70 (97.2)
Preoperative radiotherapy
Yes	6 (8.3)
No	66 (91.7)

Postoperative data	Case n (%)
Postoperative chemotherapy
Yes	12 (16.7)
No	60 (83.3)
Postoperative radiotherapy
Yes	1 (1.4)
No	71 (98.6)
Types of barriers
Periosteum	25 (34.7)
Myofascial	40 (55.6)
Capsule of joint	1 (1.4)
Vascular nerve epineurium	6 (8.3)
Invade the barrier
Yes	13 (18.1)
No	59 (81.9)
Depth
Beneath the deep fascia	72 (100.0)
Postoperative pathological margin
Negative	72 (100.0)
Reconstructive approach
Artificial vascular replacement	4 (5.6)
Flap transposition repair	11 (15.3)
Muscle transposition repair	23 (31.9)
Osteotomy and reconstruction	6 (8.3)
Grading of surgical complications
Level 1-2	20 (27.8)
Level 3	1 (1.4)
Level 4-5	0 (0.0)