Aim: In 1990 the Christchurch Hospital Sarcoma Clinic established management guidelines for patients with suspected sarcomas, recommending referral prior to investigation, biopsy and excision. The aim of this study was to determine whether these guidelines are being followed.

Method: A review of the case notes of all sarcomas referred to the Sarcoma Clinic between 1990 and 1999 was performed.

Results: There were 53 referrals, 34 (22%) from orthopaedic surgeons, 56 (37%) from general surgeons, 16 (10%) from general practice and 47 (31%) from other specialties. Only 83 (54%) of the referrals had followed the guidelines. Twenty-five (74%) of the orthopaedic referrals, 19 (34%) of the general surgical, 10 (63%) of the general practice and 29 (62%) of the other specialties had followed the guidelines. Seventy (46%) of the referrals had failed to follow the guidelines. Thirty-four (49%) of these had undergone excision inadequate for sarcoma prior to referral, of which eight had been re-excised. Twenty-four patients had not been staged prior to excision despite having a positive fine needle aspiration (FNA) in four cases. Eighteen patients (26%) had FNA or biopsy prior to imaging or referral.

Conclusion: Forty-six percent of sarcoma patients had not been treated according to the recommended guidelines. Forty-nine percent of these had inadequate primary sarcoma excision and this may have compromised their outcome. Orthopaedic surgeons had the best record for following the guidelines at 74% of referrals but this could be further improved. Doctors and especially surgeons need to be more aware of the principle of early referral of patients with suspected sarcomas.