Challenges in the management of foot and ankle sarcomas: A retrospective analysis in a tertiary cancer institute in South India

Abstract

Background: Sarcomas of the foot and ankle pose a management challenge due to anatomical complexity, rarity, and histological heterogeneity. Objectives: This study primarily aims at assessing the management challenges of sarcomas of the foot and ankle, specifically focusing on limb preservation rates, and oncologic outcomes. The secondary objectives include evaluation of surgical complications such as rates and impacts of unplanned procedures along with the analysis of functional outcomes after the treatment. Materials and Methods: This retrospective study analyses data of patients treated during January 2010 to December 2018 in the Department of Surgical Oncology at Malabar Cancer Center (Postgraduate Institute of Oncology Science and Research), a tertiary cancer center located in South India. Clinicopathologic data, treatment details, and outcomes were collected and compared. The data was analyzed using descriptive statistics, log-rank test, chi-square test, and Fisher’s exact test. Results: Out of 15 patients, 13 (86.7%) completed the planned treatment. Histopathologic review prompted a change in diagnosis in 3 out of 12 (25%) cases. Seven out of 15 (46.7%) patients underwent unplanned procedures, with short-term adverse impacts observed in 6 out of 7 (85.7%) cases. The limb salvage rate was 76.9% (10 out of 13 patients). Graft or flap coverage was needed in 7 out of 9 (77.8%) patients treated by wide excision. Wound complications were significantly higher in cases requiring soft tissue reconstruction (P, 0.005). Local recurrence with limb salvage was observed in 2 out of 13 (15.4%) patients. The mean overall survival (OS) was 58.8 months (95% CI, 44.495-73.141, SD, 7.308), and the median disease-free survival (DFS) was 46 months (95% CI, 1.496-90.504). Conclusion: Limb salvage is feasible and safe in foot and ankle sarcomas. However, management is challenging due to histological heterogeneity, delayed presentation and referral to tertiary cancer care facilities, diagnostic errors, unplanned procedures at peripheral centers, and reconstructive complications. Survival outcomes in this study were worse than those previously reported.