Surgical considerations for management of distal extremity soft tissue sarcomas

Current Opinion in Oncology

Volumn 17, Issue 4, 2005, Pages 366-369

  Ferguson, Peter C ^a,b,c  

^a MOUNT SINAI HOSPITAL   (Canada)

^b UNIVERSITY OF TORONTO   (Canada)

^c NONE   (Canada)

Author keywords

Foot; Hand; Limb salvage surgery; Sarcoma; Soft tissue reconstruction

Indexed keywords

ARM; BONE REMODELING; CANCER STAGING; CANCER SURVIVAL; CLEAR CELL SARCOMA; EPITHELIOID SARCOMA; HISTOLOGY; HUMAN; LEG; LIMB SALVAGE; PRIORITY JOURNAL; QUALITY OF LIFE; QUESTIONNAIRE; REVIEW; SOFT TISSUE SARCOMA; SYNOVIAL SARCOMA; TENDON TRANSFER; TUMOR BIOPSY; VASCULAR SURGERY;

EXTREMITIES; HUMANS; RECONSTRUCTIVE SURGICAL PROCEDURES; SALVAGE THERAPY; SARCOMA; SOFT TISSUE NEOPLASMS;

EID: 21344442853     PISSN: 10408746     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.cco.0000166651.38417.c8     Document Type: Review

References (20)

1. Gerrand CH, Wunder JS, Kandel RA, et al. The influence of anatomic location on functional outcome in lower-extremity soft-tissue sarcoma. Ann Surg Oncol 2004; 11:476-482. This excellent article reveals that functional outcome of limb salvage for sarcoma does not depend on anatomic location, although location in the foot is associated with excellent outcomes. Foot tumors are smaller than more proximal tumors and are associated with nearly normal gait.
2. Popov P, Tukiainen E, Asko-Seljavaara S, et al. Soft-tissue sarcomas of the upper extremity: surgical treatment and outcome. Plast Reconstr Surg 2004; 113:222-230, discussion 231-222. This series of 80 upper extremity sarcomas confirms that hand tumors are rare and that extracompartmental location has a poor prognosis compared with subcutaneous tumors.
3. Herr MJ, Harmsen WS, Amadio PC, Scully SP. Epithelioid sarcoma of the hand. Clin Orthop Relat Res 2005; 431:193-200. One of the larger series in the literature of patients with this unusual tumor demonstrates 85% 10-year overall survival.
4. Kato N, Mizuno O, Tamura A, et al. Clear cell sarcoma associated with multiple pulmonary metastases with structural and numerical karyotypic changes. Clin Exp Dermatol 2004; 29:614-616.
5. Zeytoonjian T, Mankin HJ, Gebhardt MC, Hornicek FJ. Distal lower extremity sarcomas: frequency of occurrence and patient survival rate. Foot Ankle Int 2004; 25:325-330. A series of bone and soft tissue sarcomas of the foot and ankle region that suggests better outcome than other extremity sarcomas, albeit with smaller tumors. It also highlights the differences in histologic types of sarcoma arising in the foot compared with other locations.
6. Miller DV, Coffin CM, Zhou H. Rhabdomyosarcoma arising in the hand or foot: a clinicopathologic analysis. Pediatr Dev Pathol 2004; 7:361-369. This small series reveals one of the rare circumstances in which distal extremity sarcomas are associated with a poorer prognosis.
7. Riad S, Griffin AM, Liberman B, et al. Lymph node metastasis in soft tissue sarcoma in an extremity. Clin Orthop Relat Res 2004; 426:129-134. Review of a large series of patients clarifies the importance of lymphatic screening in distal extremity sarcomas, as the most common sarcomas to metastasize to lymphatics include epithelioid sarcoma and clear cell sarcoma, which commonly arise in the distal extremities.
8. Wada T, Kawaguchi S, Isogai S, et al. One-bone forearm reconstruction using vascularized fibular graft for massive forearm soft-tissue and bone defect: case report. J Reconstr Microsurg 2004; 20:285-289.
9. Deune EG, Rodriguez E, Hatef D, Frassica F. Arterialized venous flow-through flap for simultaneous reconstruction of a radial artery defect and palmar forearm soft-tissue loss from sarcoma resection. J Reconstr Microsurg 2005; 21:85-91.
10. Talbot SG, Athanasian EA, Cordeiro PG, Mehrara BJ. Soft tissue reconstruction following tumor resection in the hand. Hand Clin 2004; 20:181-202. An excellent review of techniques of reconstruction of nerves, vascular structures, tendons, and fasoiocutaneous defects after limb salvage for STS in the hand.
11. Zahlten-Hinguranage A, Bernd L, Ewerbeck V, Sabo D. Equal quality of life after limb-sparing or ablative surgery for lower extremity sarcomas. Br J Cancer 2004; 91:1012-1014. Brings into question the belief that functional outcome from limb salvage surgery is superior to amputation. In sarcomas of the foot, this is likely the case.
12. Yajima H, Kobata Y, Kawamura K, et al. Radial forearm flaps for reconstruction in hand surgery. Scand J Plast Reconstr Surg Hand Surg 2004; 38:112-117. Confirmation of the effectiveness of this useful flap in a wide variety of clinical situations, including sarcoma of the hand.
13. Kim KS. Distally based dorsal forearm fasciosubcutaneous flap. Plast Reconstr Surg 2004; 114:389-396.
14. Kim JY, Subramanian V, Yousef A, et al. Upper extremity limb salvage with microvascular reconstruction in patients with advanced sarcoma. Plast Reconstr Surg 2004; 114:400-408, discussion 409-410. This series of upper extremity free flaps reveals that microvascular reconstruction is rarely necessary in the hand.
15. Langstein HN, Chang DW, Miller MJ, et al. Limb salvage for soft-tissue malignancies of the foot: an evaluation of free-tissue transfer. Plast Reconstr Surg 2002; 109:152-159.
16. Ozkan O, Coskunfirat OK, Ozgentas HE. The use of free anterolateral thigh flap for reconstructing soft tissue defects of the lower extremities. Ann Plast Surg 2004; 53:455-461.
17. Kim JY, Youssef A, Subramanian V, et al. Upper extremity reconstruction following resection of soft tissue sarcomas: a functional outcomes analysis. Ann Surg Oncol 2004; 11:921-927. This series of upper extremity sarcoma confirms the importance of effective flap reconstruction, as flap complications are associated with marked reduction in functional outcomes scores. Also, anatomic location has no effect on functional outcomes in the upper extremity.
18. Deshmukh R, Mankin HJ, Singer S. Synovial sarcoma: the importance of size and location for survival. Clin Orthop Relat Res 2004; 419:155-161. Excellent article documenting the prognostic factors for synovial sarcoma. Although hand or foot location appears to be associated with better outcome, this article reveals that after Cox multivariate analysis, this is not the case.
19. McKee MD, Liu DF, Brooks JJ, et al. The prognostic significance of margin width for extremity and trunk sarcoma. J Surg Oncol 2004; 85:68-76. This series is important in demonstrating prognostic factors for extremity STS. Tu-mor grade, size, and depth are important for development of metastases, whereas margins are predictive of local recurrence.
20. Gronchi A, Casali PG, Mariani L, et al. Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: a series of patients treated at a single institution. J Clin Oncol 2005; 23:96-104. Review of a large series of sarcoma patients confirms that surgical margins are important predictor of local recurrence but not of systemic relapse or overall survival.