title: Extremity soft tissue sarcoma resections: how wide do you need to be?
abstract: BACKGROUND
  Sarcomas require a wide margin of resection including a cuff of normal tissue to minimize the risk of local recurrence. The amount of tissue that constitutes a wide margin is unclear in the literature.
  
  
  OBJECTIVE
  We therefore determined whether a close resection margin for soft tissue sarcoma resulted in an increased incidence of locally recurrent disease and whether additional factors, including radiation therapy, outside biopsies, and tumor biology, affected the risk of local recurrence.
  
  
  METHODS
  We retrospectively reviewed 117 patients with soft tissue sarcomas resected with negative margins from 2001 to 2007. Gross specimens were inked and the closest macroscopic margins were sent for microscopic examination. Resection margins were categorized as less than 1 mm, 1-5 mm, or greater than 5 mm. We evaluated additional factors that might influence local recurrence, including radiation therapy, outside biopsies, sarcoma type, grade, and stage at presentation, and development of metastatic disease.
  
  
  RESULTS
  Four of 117 patients (3.4%) developed local recurrence. The incidence of local recurrence was similar in patients with less than 1-mm margins and greater than 1-mm margins: two of 45 patients (4.4%) and two of 64 patients (3.1%), respectively. Due to the low number of local recurrences, quantitative margin extent and the other factors evaluated did not affect local recurrence.
  
  
  CONCLUSIONS
  The extent of a margin necessary to prevent local recurrence of soft tissue sarcoma remains unclear as the power of our study was limited by the low number of local recurrences. Relatively low local recurrence rates can be achieved even with close margins.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA. dking@mcw.edu
authors.forename: David M
authors.initials: DM
authors.lastname: King
authors.forename: Donald A
authors.initials: DA
authors.lastname: Hackbarth
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirkpatrick
mesh_terms: D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*
references.citation: J Clin Oncol. 1996 May;14(5):1679-89
references.pmid: 8622088
references.citation: Cancer. 1994 Mar 15;73(6):1652-9
references.pmid: 8156492
references.citation: Ann Surg. 2010 Mar;251(3):506-11
references.pmid: 20130465
references.citation: Ann Surg Oncol. 2010 Aug;17(8):2102-11
references.pmid: 20217247
references.citation: Clin Orthop Relat Res. 2004 Feb;(419):165-72
references.pmid: 15021149
references.citation: J Cancer Res Clin Oncol. 1995;121(9-10):555-63
references.pmid: 7559736
references.citation: Recent Results Cancer Res. 2009;179:229-42
references.pmid: 19230543
references.citation: Ann Surg. 2002 Mar;235(3):424-34
references.pmid: 11882765
references.citation: Int J Radiat Oncol Biol Phys. 2010 Jul 15;77(4):1191-7
references.pmid: 20056340
references.citation: Ann Surg. 2003 Feb;237(2):218-26
references.pmid: 12560780
references.citation: J Bone Joint Surg Br. 2001 Nov;83(8):1149-55
references.pmid: 11764430
references.citation: Int J Radiat Oncol Biol Phys. 2008 Jan 1;70(1):139-44
references.pmid: 17919843
references.citation: J Surg Oncol. 1993 Apr;52(4):223-30
references.pmid: 8468983
references.citation: ANZ J Surg. 2006 Mar;76(3):104-9
references.pmid: 16626341
references.citation: Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):1196-203
references.pmid: 18207661
references.citation: Surg Oncol. 2005 Jul;14(1):1-9
references.pmid: 15777885
references.citation: Gan To Kagaku Ryoho. 1989 Apr;16(4 Pt 2-3):1802-10
references.pmid: 2730075
references.citation: J Surg Oncol. 2004 Feb;85(2):68-76
references.pmid: 14755506
references.citation: J Clin Oncol. 1999 Oct;17(10):3252-9
references.pmid: 10506627
references.citation: Int J Radiat Oncol Biol Phys. 2010 Jul 1;77(3):843-50
references.pmid: 20005638
references.citation: J Clin Oncol. 2005 Jan 1;23(1):96-104
references.pmid: 15625364
references.citation: Clin Orthop Relat Res. 2010 Nov;468(11):3003-11
references.pmid: 20645035
references.citation: Clin Orthop Relat Res. 2003 Oct;(415):4-18
references.pmid: 14612624
references.citation: Cancer. 2003 May 15;97(10):2530-43
references.pmid: 12733153