Operative Treatment of Soft-Part Sarcomas

Abstract

Although soft-part sarcomas are radiosensitive, their rate of curability by radiation alone is limited, and surgical resection is accepted as the treatment of choice for most primary tumors. Adjuvant therapy with radiation might well affect the scope of the operation employed, and the data available for defining the value of this adjuvant treatment will be discussed in Chapter 11. The major treatment decision for sarcomas relates to the extent of surgical resection employed, a factor primarily dictated by the anatomic relationships of the individual tumor. Most sarcomas arise in an extremity where a decision regarding amputation must be made. The key principle of resection is that of achieving surgical margins adequate to prevent local treatment failure. In this regard there is some degree of uncertainty as to how wide the gross margins must be, whether total compartmental excision is always required, and the possible role of the histologic grade of the sarcoma in the choice of operative procedure. The heterogeneity of sarcomas, from the standpoint of histologic types, histologic grades, and anatomic locations, does make definition of the optimal operation difficult, but the procedures illustrated in subsequent chapters will serve as general guides for the surgeon.