title: The effect of the setting of a positive surgical margin in soft tissue sarcoma.
abstract: BACKGROUND
  The objectives of this study were to evaluate the risk of local recurrence and survival after soft tissue sarcoma (STS) resection with positive margins and to evaluate the safety of sparing adjacent critical structures.
  
  
  METHODS
  One hundred sixty-nine patients with localized STS who had positive resection margins were identified from a prospective database. Patients who had positive margins were stratified into 3 groups, each representing a specific clinical scenario: critical structure positive margin (eg major nerve, vessel, or bone), tumor bed resection positive margin, and unexpected positive margin. The rates of local recurrence-free survival (LRFS) and cause-specific survival (CSS) were calculated and compared with relevant control patients who had negative margins after STS resection.
  
  
  RESULTS
  After planned close dissection to preserve critical structures, the 5-year LRFS and CSS rates both depended on the quality of the surgical margins (97% and 80.3%, respectively, for those with negative margins vs 85.4% and 59.4%, respectively, for those with positive margins; P = .015 and P = .05, respectively). Negative margins achieved through resection of critical structures because of tumor invasion or encasement only slightly improved the 5-year rates of LRFS (91.2%) and CSS (63.6%; P = .8 and P = .9, respectively). The lowest 5-year LRFS and CSS rates were 63.4% and 59.2%, respectively, after an unexpected positive margin during primary surgery.
  
  
  CONCLUSIONS
  After patients undergo resection of STS with positive margins, oncologic outcomes can be predicted based on the clinical context. Sparing adjacent critical structures in this setting is safe and contributes to improved functional outcomes.
authors.affiliation: Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: O'Donnell
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Griffin
authors.forename: William C
authors.initials: WC
authors.lastname: Eward
authors.forename: Amir
authors.initials: A
authors.lastname: Sternheim
authors.forename: Charles N
authors.initials: CN
authors.lastname: Catton
authors.forename: Peter W
authors.initials: PW
authors.lastname: Chung
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: Peter C
authors.initials: PC
authors.lastname: Ferguson
authors.forename: Jay S
authors.initials: JS
authors.lastname: Wunder
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate
keywords: morbidity; recurrence; sarcoma; survival