Soft tissue sarcomas of the groin: Diagnosis, management, and prognosis

BACKGROUND: Soft tissue sarcomas (STS) of the groin may present a difficult problem because of misdiagnosis as groin hernia and proximity to major neu rovascular structures. We evaluated our management and survival in a large cohort of patients. STUDY DESIGN: Patients treated between July 1, 1982 and July 1, 1998 with p rimary or recurrent STS of the groin were included. Groin sarcomas were def ined as those tumors within 5 cm of the inguinal crease. Patient, tumor, cl inical, and survival data were analyzed using a log rank test and Cox regre ssion. RESULTS: We treated and followed 88 patients with STS of the groin. The med ian age was 52 years (range 16 to 86 years) and 55 patients (63%) were male . Disease-specific survival was 72% at 5 years. Tumors tended to be larger than 5 cm (52%), deep (72%), and high-grade (60%). Unfavorable prognostic f actors for disease-specific survival were high grade (p < 0.001), neurovasc ular invasion (p < 0.001), positive margin (p < 0.01), deep depth (p < 0.01 ), and selection for adjuvant therapy (p < 0.005). Multivariate analysis in dicated age greater than 50 years (p < 0.05), high grade (p < 0.001), neuro vascular invasion (p < 0.001), and positive microscopic margins (p < 0.001) . Fourteen patients (16%) were diagnosed vith STS at hernia operation then went on to a definitive operation with no impact on survival. Seventeen pat ients (19%) had involvement of a major vessel or nerve, and 5 of these-ulti mately required amputations, 3 for local recurrence. CONCLUSIONS: High grade, neurovascular invasion, and positive microscopic m argins are associated with poor outcomes. The biology of these tumors is si milar to other extremity STS, and similar principles of management apply. E ven with neurovascular involvement, most patients with primary groin STS do not require amputation. (J Am Coll Surg 2001; 193:130-136. (C) 2001 by the American College of Surgeons).