title: Atypical lipomatous tumors: should they be treated like other sarcoma or not? Surgical consideration from a bi-institutional experience.
abstract: BACKGROUND
  To identify the best surgical approach to atypical lipomatous tumors we reviewed 171 patients who underwent surgery at two sarcoma referral centers with different surgical policies.
  
  
  METHODS
  Of the 151 patients (88 %) with primary tumors, 95 were treated at Institution A and 76 were treated at Institution B. At Institution A, a wide surgical resection, including a slight cuff of soft tissue around the mass, was adopted, which was defined as marginal resection (MR) according to the Enneking classification. At Institution B, a simple tumor resection (SR), according to the Enneking classification, was employed. En bloc surgical resection was the goal in both centers. The primary outcomes of the study were local recurrence-free survival (LRFS), incidence of secondary dedifferentiation at recurrence, and presence of residual tumor after re-excision.
  
  
  RESULTS
  Sixteen patients (9 %) had local recurrence. The 10-year LRFS was 82 %. No cases of secondary dedifferentiation were observed. Residual tumor after re-excision was found in 46 % of cases. In univariate analysis, sclerosing subtype, tumor rupture, and SR were unfavorable prognostic factors for LRFS. Sclerosing subtype and tumor rupture were independent prognostic factors for LRFS in multivariate analysis. SR was significantly associated with tumor rupture.
  
  
  CONCLUSIONS
  Sclerosing subtype and tumor rupture are unfavorable prognostic factors for local recurrence. MR is associated with a lower risk of tumor rupture than SR. Neurovascular and major muscle resections are not necessary in principle. Re-excision after unplanned surgery is not always mandatory. A preoperative core needle biopsy could be useful in identifying the sclerosing subtype.
authors: Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy, chiara.mussi@humanitas.it.
authors: Chiara Erminia
authors: CE
authors: Mussi
authors: Primo
authors: P
authors: Daolio
authors: Matteo
authors: M
authors: Cimino
authors: Fabio
authors: F
authors: Giardina
authors: Rita
authors: R
authors: De Sanctis
authors: Emanuela
authors: E
authors: Morenghi
authors: Antonina
authors: A
authors: Parafioriti
authors: Maria S
authors: MS
authors: Bartoli
authors: Stefano
authors: S
authors: Bastoni
authors: Luca
authors: L
authors: Cozzaglio
authors: Piergiuseppe
authors: P
authors: Colombo
authors: Vittorio
authors: V
authors: Quagliuolo
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008067:Lipoma / Q000473:pathology / Q000601:surgery*; D008080:Liposarcoma / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual / Q000601:surgery; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D016896:Treatment Outcome