Conservative surgery for well-differentiated liposarcomas of the extremities adjacent to major neurovascular structures.
BACKGROUND
There is no clear consensus as to the appropriate nomenclature and the best surgical strategy for well-differentiated liposarcomas. A wide surgical excision is recommended over marginal resection for local control of well-differentiated liposarcomas. However, this surgical procedure should be reconsidered for lesions, which come into contact with major neurovascular structures.


METHODS
Between 1998 and 2004, 12 well-differentiated liposarcomas of the extremities were treated at our institute. Among them, nine lesions (75%) adjacent to major nerves or blood vessels were marginally resected with careful dissection of these critical structures. The clinical outcomes were reviewed for a mean follow-up time of 4 years.


RESULTS
Seven patients continued to be disease-free without any loss of limb function. One patient developed a local recurrence 30 months postoperatively. The other patient with a foot lesion involving the fourth metatarsal bone has experienced slight difficulty in gait-balancing due to the fourth toe amputation, but remains free of disease. The local control rate was 88.9%, even though seven lesions were resected with positive surgical margins.


CONCLUSIONS
Our findings suggested that well-differentiated liposarcomas frequently arise in close proximity to major nerves or blood vessels. Marginal resection alone seems to be adequate for these lesions to preserve critical structures.
Kubo
Tadahiko
T
Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. kubot@hiroshima-u.ac.jp
Sugita
Takashi
T
Shimose
Shoji
S
Arihiro
Koji
K
Ochi
Mitsuo
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005121:Extremities / Q000098:blood supply* / Q000294:innervation* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008080:Liposarcoma / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000601:surgery*