Surgical management of localized soft tissue tumors

Abstract

Soft tissue tumors are rare and can arise from a variety of soft tissues and viscera in a variety of body sites. Their management requires a thorough understanding of the biology of the different histologies and molecular subtypes as well as the constraints of specific anatomic sites. The surgical approach has undergone significant changes thanks to a better understanding of the natural history of the different histologic subtypes, the importance of site, and the different sensitivity to available drugs. The soft tissue tumor family includes 3 major, distinct categories: desmoid-type fibromatosis, soft tissue sarcoma, and gastrointestinal stromal tumor. In general, limb-sparing and function-sparing approaches should be used when feasible for tumors located in the extremities and girdles. Resections of adherent structures/viscera, which may be close but not invaded, may be needed in tumors arising in the retroperitoneum/abdomen to minimize microscopic intralesional margins, maximize local tumor control, and possibly improve survival. Margins of resection and the use of adjuvant/neadjuvant radiation therapy and/or chemotherapy are contingent on an accurate histologic diagnosis. Treatment planning should include multidisciplinary consultation to determine optimal therapy, taking into consideration tumor histology, site and extent of the disease, its natural history and sensitivity to available treatments, surgical challenges, and-of course-quality of life. Cancer 2014;120:2638-48.

The Hippo signal transduction pathway in soft tissue sarcomas

“…A combination of surgery, cytotoxic chemotherapy and radiotherapy are the mainstays of current treatment with some types of sarcoma being treated with neoadjuvant chemo-radiotherapy prior to definitive surgery [23][24][25]. Immunotherapy and targeted, novel biologic therapies are also now being evaluated in the treatment of specific types of sarcoma [26][27][28][29] and as we show below, targeting the Hippo pathway in sarcoma should already be possible with existing drugs.…”

Practical Issues for Retroperitoneal Sarcoma

“…This type of trial is investigating the potential for external beam radiotherapy (EBRT) to reduce local regional failure. 36 Proponents of preoperative radiation cite the potential benefits of potentially using lower doses, while the tumor displaces radiosensitive viscera outside the field of radiation. 37 Proponents also claim gross tumor volume can be more adequately defined, which would allow for more accurate preoperative treatment planning.…”

Use of negative pressure wound therapy as an adjunct to the treatment of extremity soft-tissue sarcoma with ulceration or impending ulceration

“…The global incidence of STS is ~5 cases per 100,000 individuals (1,2). The most common anatomical sites of occurrence are the extremities, followed by the trunk and retroperitoneum (3). En bloc resection of tumors along with a cuff of healthy tissue is the typical treatment for STS, as incomplete excision with positive microscopic surgical margins has been observed to be the strongest risk factor for local recurrence and distant metastasis (4).…”

“…En bloc resection of tumors along with a cuff of healthy tissue is the typical treatment for STS, as incomplete excision with positive microscopic surgical margins has been observed to be the strongest risk factor for local recurrence and distant metastasis (4). Due to an increased understanding of the pathology of STS, the evolution of surgical techniques and the development of adjuvant therapies, including radiotherapy (RT) and chemotherapy (CT), limb-sparing surgery has become the preferred choice of treatment due to an improved preservation of limb function and a post-operative prognosis equivalent to amputation (3)(4)(5). At present, only 10% of patients with STS of the extremities undergo amputation surgery (5).…”

“…This adds to the difficulty of surgical techniques, therefore, patients are expected to demonstrate an increased risk of major wound complications. Previous studies have reported a wide variety of wound complications following reconstruction, including cellulitis, abscess, wound dehiscence, seroma, hematoma and necrosis of the muscle flap (1)(2)(3)(4)(5)(6)(7). These complications can lead to unfavorable outcomes of treatment and postponed adjuvant therapy.…”