The effect of the setting of a positive surgical margin in soft tissue sarcoma

Authors

  • Patrick W. O'Donnell MD, PhD,

    1. Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
    3. Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Anthony M. Griffin MS,

    1. Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • William C. Eward DVM, MD,

    1. Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
    3. Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Amir Sternheim MD,

    1. Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
    3. Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Charles N. Catton MD,

    1. Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Peter W. Chung MD,

    1. Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Brian O'Sullivan MD,

    1. Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Peter C. Ferguson MD,

    1. Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
    3. Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Jay S. Wunder MD

    Corresponding author
    1. Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
    3. Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
    • Corresponding author: Jay S. Wunder, MD, 476-600 University Avenue, Mount Sinai Hospital, Toronto, Ontario, Canada M5G 1X5; Fax: (416) 586-8611; jwunder@mtsinai.on.ca

    Search for more papers by this author

  • See editorial on pages 2803–5, this issue.

Abstract

BACKGROUND

The objectives of this study were to evaluate the risk of local recurrence and survival after soft tissue sarcoma (STS) resection with positive margins and to evaluate the safety of sparing adjacent critical structures.

METHODS

One hundred sixty-nine patients with localized STS who had positive resection margins were identified from a prospective database. Patients who had positive margins were stratified into 3 groups, each representing a specific clinical scenario: critical structure positive margin (eg major nerve, vessel, or bone), tumor bed resection positive margin, and unexpected positive margin. The rates of local recurrence-free survival (LRFS) and cause-specific survival (CSS) were calculated and compared with relevant control patients who had negative margins after STS resection.

RESULTS

After planned close dissection to preserve critical structures, the 5-year LRFS and CSS rates both depended on the quality of the surgical margins (97% and 80.3%, respectively, for those with negative margins vs 85.4% and 59.4%, respectively, for those with positive margins; P = .015 and P = .05, respectively). Negative margins achieved through resection of critical structures because of tumor invasion or encasement only slightly improved the 5-year rates of LRFS (91.2%) and CSS (63.6%; P = .8 and P = .9, respectively). The lowest 5-year LRFS and CSS rates were 63.4% and 59.2%, respectively, after an unexpected positive margin during primary surgery.

CONCLUSIONS

After patients undergo resection of STS with positive margins, oncologic outcomes can be predicted based on the clinical context. Sparing adjacent critical structures in this setting is safe and contributes to improved functional outcomes. Cancer 2014;120:2866–2875. © 2014 American Cancer Society.

Ancillary