Soft-tissue sarcoma of the extremity. Experience with limb-sparing surgery.

OBJECTIVES

To assess the degree to which limb-sparing surgery is implemented in patients with soft-tissue sarcoma, and its outcome.

DESIGN AND SETTING

A detailed review of 40 patients who were all tertiary referrals to one surgeon, and general review of all 215 patients with sarcoma treated in South Australia between 1986 and 1992.

INTERVENTIONS

Conservation of the limb by wide resection or marginal resection of soft tissue, combined when necessary with radiotherapy. Amputation was used when limb conservation failed or was not possible.

MAIN OUTCOME MEASURES

Median survival time after treatment.

RESULTS

Limb-sparing treatment 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 sarcoma revealed a higher initial amputation rate and a lower use of combined 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 limb-sparing surgery is well established, but is not yet as widely practised for limb sarcomas as it could be. Delay in diagnosis is a significant problem.