Aim of Study: Assess clinical outcome and function of planned marginal excision of low grade liposarcoma of the forearm.

Material and Methods: Between 1997 and 2005 15 of 27 soft tissue sarcomas of the forearm were liposarcoma.

13 presented in the extensor compartment and 2 flexor compartment at the level of the distal radius. All presented with a painless mass. 5 patients with neurological symptoms. 4 involving the post interosseus nerve and 1 radial nerve. MRI was the diagnostic imaging technique of choice, 2 had biopsies where there was atypical imaging features.

Treatment and Results: All treated by planned marginal excision in view of proximity of neurovascular structures. The majority of tumours of the extensor compartment of the forearm were either involving or abutting the post interosseus nerve or neurovascular conduit.

All underwent planned marginal excision preserving juxtaposed peripheral nerve. There were no radial, spiral or PIN nerve palsies. One patient presented with PIN palsy had partial resolution of symptoms and function. I wound infection

Conclusion: Low grade lipoma-like liposarcomas have low metastatic potential. In the forearm a wide margin would mean ablation of critical neurological structures and planned marginal excision results in good function and to date no evidence of local recurrence at 2–9 year follow up.

Purpose: To quantify the functional outcome of patients who were known to have sciatic nerve involvement pre-operatively and went on to have nerve preserving surgery utilising a planned marginal excision with epineurectomy.

Materials and Methods: Ten patients with large volume posterior thigh soft tissue sarcoma with known sciatic nerve involvement were reviewed between 1997 and 2004. Nine underwent surgery with extended epineurectomy of the sciatic nerve and planned marginal excision.

All patients underwent staging and follow up at Sarcoma Clinic with functional assessment and TESS evaluation.

Results: There were seven low and two high grade posterior thigh tumours of which nine were liposarcoma and 1 haemangiopericytoma. Two were recurrent and eight primary. There were five men and five women with a mean age of 77.

Nine patients underwent planned marginal excision. Sciatic nerve involvement was 13–30cm in eight cases and in one case the sciatic nerve was abutting the tumour throughout its length. There was soft tissue reconstruction in three cases using fascial adductor or gracilis graft for sciatic nerve cover and one with superficial femoral nerve and vein resection requiring ipsilateral saphenous reconstruction. The remainder underwent direct primary reconstruction.

Four patients underwent radiotherapy 46–60 Gy.

There was no local recurrence of disease within 14 – 96m follow-up. There was one patient with post radiation wound breakdown that resolved.

Three patients have died of unrelated causes. To date there has been no evidence of local recurrence of disease at FU.

Conclusion: Planned marginal excision of low grade large volume posterior thigh sarcomas with extensive sciatic nerve involvement can be successfully treated with preservation of the sciatic nerve without significant morbidity and resultant good limb function.

The aim of this study was to retrospectively assess the long term results of the surgical excision of a series of proximal tibio-fibula joint ganglions. They are uncommon tumours in this position (prevalence < 1%) and mimic more sinister pathology creating diagnostic difficulty. From the Queensland Orthopaedic Oncology Database, twelve patients were identified who had presented with proximal tibio-fibular joint cysts between 1991 and 2004 and proceeded to surgery. There were four males and eight females with an average age of 44 years (18–75). One patient had bilateral cysts but elected to only have one side resected. The side distribution was equal. All patients presented with a swelling and ten with pain. Two patients presented with a common peroneal nerve palsy. All patients obtained a marginal excision and histology confirmed a ganglion cyst. Patients were seen at clinic or contacted by phone to assess continued symptoms or recurrence. At mean long term follow up of 49 months (8–168), eight patients had had no recurrence. One patient postoperatively had a transient common peroneal nerve palsy. Of the four patients who had had a recurrence, one patient’s surgery is planned and another patient at 5 months post surgery is symptom free following further resection. The two remaining patients have required re-resection but have presented with further recurrence within 1 year. The common peroneal nerve palsies resolved between 6–12 weeks post surgery. A number of case reports record neurological involvement by direct epineurial involvement but this behaviour was not observed in our series. Review of the literature shows no larger series than ours. We conclude that cysts arising in this region commonly present with pain, swelling and neurology. Recurrence rate is high (33%) and further marginal resection is unlikely to lead to cure. More aggressive surgery such as joint excision or arthrodesis may then be necessary.

The aim of this study was to assess the significance of the extent and adequacy of the surgical margin on three outcome variables; survival, metastasis and local recurrence. We statistically analysed (Cox proportional hazards regression modelling) 279 consecutive patients who presented with soft tissue sarcoma without meta-static disease. They were treated by a single surgeon to a standard protocol in two centres. In terms of overall survival, the failure to achieve a wide surgical margin by contaminating the resection, led to an elevenfold increase in the relative death rate (p=0.04). However, where the margin was not contaminated (even if the margin was closer than 1 mm) then the overall survival rate was similar across all groups of patients with a clear margin up to 20 mm. A large margin greater than 20mm afforded the lowest risk to overall survival. The extent of the surgical margin was not statistically significant in the development of metastatic disease. The presence of a contaminated surgical margin and a narrow margin less than 1mm led to a significantly higher rate of local recurrence (p=0.02) A margin greater than 1 mm allowed a satisfactory outcome in terms of a low local recurrence rate and the extent of the margin up to 20mm was not statistically important. Patients who had radical resections did poorly and generally represent a group where palliative surgery was performed, and there was a very high relative metastasis and death rate. Our study provides statistically significant evidence that increasing width of resection improves local control and overall survival. However a narrow margin due to anatomical constraints such as bone or neurovascular structures does not significantly compromise patient outcome and this provides guidance for surgical decision making in limb salvage surgery.