DISEASE CLEARANCE FOLLOWING SURGERY AND METASTASES IN PATIENTS WITH FUNGATING SOFT TISSUE TUMOUS OF THE LIMB

Abstract

Introduction: Radical excision and amputation are the surgical options for advanced soft tissue tumours (STS) of the limbs. The sheer size of these advanced tumours in relation to the limb makes limb sparing surgery difficult. The rate of positive margins is high and further management options are quite limited.

Patients & Methods: We have identified 17 patients (13 males, 4 females) with sarcomas with skin changes at presentation, including recurrences and primary referrals. The average age was 67 (37–83) years. 11 patients had lower limb tumours and 6 had upper limb tumours. All patients were managed either with radical excision or amputation. Post op radiotherapy and chemotherapy was used s adjuvants when appropriate. All patients were followed up with regular clinical and radiological assessments for recurrences and metastases. The results of adequacy of clearance, recurrences, metastases and overall survival are presented.

Results: The follow-up was an average of 30 (7–120) months. Two patients had primary amputations and 15 had wide excision. Four patients had distant metastases at the time of referral. Positive margins were identified in 8 of the 17 patients after primary surgery. 5 patients had a single recurrence and 3 patients had two recurrences. Eight patients needed revision surgery (3 amputations/5 wider excisions) for a positive margin or a recurrence. A total of 8 patients had metastases by 1 year. Overall disease free survival in this cohort was 20 (3–41) months.

Conclusion: We encountered a very high rate of positive margins with high morbidity which seems quite common after limb sparing surgery in fungating STS. Amputation comparatively attains better local disease control but probably does not affect the overall survival.