Unexpected resection of soft-tissue sarcoma - More mutilating surgery, higher local recurrence rates, and obscure prognosis as consequences of inproper surgery

Sixteen referred patients were reviewed after excision of an unexpected sof t-tissue sarcoma of the extremities. Eight tumors were located in the muscl e deep to the fascia, and 8 lesions exceeded the size of 5 cm. The lack of awareness by the primary physician towards the possibility of a malignant l esion was striking, although 11 of 16 tumors presented as a newly formed ma ss. No imaging studies were done in 11 patients. Fine needle biopsy was uns uccessfully performed in 3 patients. Eleven lesions (63%) were high-grade. Resection margins were intralesional in 12 (75%) and marginal in 3 (25%) pa tients. Surgical oncologic rules were disregarded in 7 cases, including ope ning of probably uninvolved joints. Postoperative magnetic resonance imagin g (MRI) scans showed a poor negative predictive value for residual tumor. R epeated resection, including three amputations, revealed residual tumor in 10 patients (63%). Four patients received adjuvant local radiation, with ad ditional chemotherapy in 2 of them. At an average follow-up of 4.5 years (r ange 15-149 months). 4 patients (25%) had developed distant metastases with a local recurrence in 3 (19%). There was one tumor-related death (6%). Phy sicians' alertness towards the possible malignancy of an enlarging mass can not be overemphasized. Evaluation by adequate imaging techniques, biopsy, a nd definitive resection and reconstruction should be performed by an oncolo gically trained orthopaedic surgeon. Inadequate primary excision leads to a high local recurrence rate and more mutilating surgery and obscures the lo ng-term prognosis.