SOFT-TISSUE SARCOMA OF THE EXTREMITY - EXPERIENCE WITH LIMB-SPARING SURGERY

Objectives: To assess the degree to which limb-sparing surgery is impl emented in patients with soft-tissue sarcoma, and its outcome. Design and setting: A detailed review of 40 patients who were all tertiary re ferrals to one surgeon, and general review of all 215 patients with sa rcoma treated in South Australia between 1986 and 1992. Interventions: Conservation of the limb by wide resection or marginal resection of s oft tissue, combined when necessary with radiotherapy. Amputation was used when limb conservation failed or was not possible. Main outcome m easures: Median survival time after treatment. Results: Limb-sparing t reatment was successful in 37 of the group of 40 patients. Thirty-two patients received adjuvant radiotherapy, and 19 received chemotherapy. Median survival time was 35 months. Review of all 215 patients with s arcoma revealed a higher initial amputation rate and a lower use of co mbined treatment methods than in our series. Twenty-six patients (65%) were initially incorrectly diagnosed before referral, resulting in a median delay in treatment of 16 weeks. Conclusions: The concept of lim b-sparing surgery is well established, but is not yet as widely practi sed for limb sarcomas as it could be. Delay in diagnosis is a signific ant problem.