The adequacy of resection margin for non-infiltrative soft-tissue sarcomas. Issue 2 (February 2021)

• Record Type: Journal Article
• Authors: Fujiwara, Tomohiro; Stevenson, Jonathan; Parry, Michael; Tsuda, Yusuke; Kaneuchi, Yoichi; Jeys, Lee
• Is Part Of: European journal of surgical oncology. Volume 47:Issue 2(2021)
• Page Start: 429
• Page End: 435
• Publication Date: 2021-02
• Subjects: Soft-tissue sarcoma -- Non-infiltrative subtype -- Margin -- Local recurrence -- Prognosis; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.06.020
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Objectives: There remains no consensus on what constitutes an adequate margin of resection for non-infiltrative soft-tissue sarcomas (STSs). We aimed to investigate the role of resection margins in millimetres for non-infiltrative STSs. Methods: 502 patients who underwent surgical resection for a localized, non-infiltrative, high-grade STSs were studied. The prognostic significance of margin width was analysed and compared with the conventional R- and R+1-classification of surgical margins. Results: The overall local recurrence (LR) rate was 13%; 9% and 27% with negative and positive margins, respectively ( p < 0.001). In patients with negative margins, the LR rates were greater than 10% in patients with margins ≤5.0 mm but reduced to less than 4% with margins >5.0 mm. When classified by the R- (or R+1)-classification, the 5-year cumulative LR incidence was 8%, 23% (16%), and 31% for R0, R1, and R2, respectively, which did not stratify the LR risk with negative margins. On the other hand, an accurate risk stratification was possible by metric distance; the 5-year cumulative incidence of LR was 29%, 10%, and 1% with 0 mm, 0.1–5.0 mm, and >5.0 mm, respectively ( p < 0.001). This classification also stratified the LR risk in patients with or without adjuvant radiotherapy. Conclusion: While a negative margin is essential to optimize local control in patients with non-infiltrative STSs, surgical margin width greater than 5 mm minimises the risk of local failure regardless of the use of adjuvant radiotherapy.