Margin Assessment in Soft Tissue Sarcomas: Review of the Literature

Abstract

Adequacy of margins must take into consideration both the resection margin width (quantity) and anatomic barrier (quality). There are several classification schemes for reporting surgical resection margin status for soft tissue sarcomas (STS). Most of the studies regarding treatment outcomes in STS included all histologic grades and histological subtypes, which include infiltrative and non-infiltrative subtypes and are very heterogeneous in terms of both histologic characteristics and treatment modalities (adjuvant treatments or not). This lack of consistency makes it difficult to compare results from study to study. Therefore, there is a great need for evidence-based standardization concerning the width of resection margins. The aim of this narrative review is to provide a comprehensive assessment of the literature on margins, and to highlight the need for a uniform description of the margin status for patients with STS. Patient cases should be discussed at multidisciplinary tumor boards and treatments should be individualized to clinical and demographic characteristics, which must include also a deep knowledge of specific histotypes behaviors, particularly infiltrative ones.

Vascular Proximity Increases the Risk of Local Recurrence in Soft-Tissue Sarcomas of the Thigh—A Retrospective MRI Study

“…Moreover, we confirm that two of the most important predictors of outcome are histology/histologic subtype and grade [ 1 ]. Specific infiltrative STS subtypes such as myxofibrosarcoma and undifferentiated pleomorphic sarcoma have an increased risk of LR regardless of the adequacy of surgical margins [ 7 , 20 , 21 , 22 ]. A non-significant difference in the LR rate was observed concerning the adequacy of surgical margins.…”

“…Some STS subtypes (myxofibrosarcoma and undifferentiated pleomorphic sarcoma) may present a specific focal-infiltrative pattern and were therefore classified as “infiltrative subtypes” [ 7 ].…”

“…Several MRI features can change drastically the surgical approach, above all the identification of the so-called “tail sign”, which can be observed in some “infiltrative” histotypes [ 6 ]. In these cases, a wider resection is suggested [ 7 ]. In addition, MRI is the imaging of choice to assess the relationship between the tumor mass and vascular bundles.…”

Novel Insights into the Immunotherapy of Soft Tissue Sarcomas: Do We Need a Change of Perspective?

“…Patients with STSs are managed according to the generally accepted guidelines and those with localized and resectable diseases are treated by surgery [18]. The mainstay of STS treatment is a complete surgical resection of the tumor with ensured negative margins [19]. Although major improvements in the local control rates are achieved, the success of surgery critically depends on the tumor location, tumor size, the involvement of nearby structures, and other factors [19,20].…”

“…The mainstay of STS treatment is a complete surgical resection of the tumor with ensured negative margins [19]. Although major improvements in the local control rates are achieved, the success of surgery critically depends on the tumor location, tumor size, the involvement of nearby structures, and other factors [19,20]. With optimally surgically treated localized disease, approximately 50% of high-grade STS patients eventually develop pulmonary metastases within five years [2,[21][22][23].…”