title: Surgical resection of massive liposarcomas at the extremities: a 10-year experience in a referral musculoskeletal sarcoma unit.
abstract: BACKGROUND
  There is still no consensus regarding the management of patients with massive liposarcomas located in the extremities. Several discrepancies related to the aggressiveness of the surgery and the application of concomitant radiotherapy and chemotherapy treatments remain controversial. The purpose of this study was to analyse the clinicopathological characteristics, prognostic factors and outcomes of a series of patients with massive liposarcomas of the extremities who were treated at a referral hospital specializing in musculoskeletal oncology.
  
  
  METHODS
  This was an observational, descriptive and retrospective case series covering 10 years of clinical practice. The records of 26 adults, 14 men and 12 women, with localized massive liposarcomas in the extremities were studied. The average age was 53 years. The patients were treated from January 2003 until January 2012. Wide surgical resections with limb-sparing surgeries were performed for most patients (96.2 %).
  
  
  RESULTS
  The average tumour size was 15.1 ± 6.8 cm in the greatest dimension. Regarding the histological subtypes, there were 11 well-differentiated or atypical lipomatous tumours (42.3 %), 10 myxoid (38.5 %) and 5 (19.2 %) round cell and pleomorphic liposarcomas. Regarding the malignancy grades, 19 cases (73 %) were classified as low grade. Among these low-grade tumours predominated the well-differentiated subtype (57.9 %). Within high-grade tumours, the round cell and pleomorphic subtype was most frequent (57.1 %; p = 0.011). Radiotherapy was additionally applied to 12 patients (46.2 %) and adjuvant chemotherapy to 5 (19.3 %). Tumour recurrence was observed in only 2 cases (7.7 %). Only 1 of these cases developed lung metastatic dissemination.
  
  
  CONCLUSIONS
  Across the entire series, these massive tumours did not compromise the survival of the patients. The histologic subtype and the malignancy degree were closely related. Proper and early diagnosis and therapeutic management of these patients via the application of wide-margin surgical excision are essential to ensure long-term survival.
authors.affiliation: Department of Orthopedic Surgery, Hospital de Sagunto, Valencia, Spain. barbara_ortiz_89@mail.ucv.es.|Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain. barbara_ortiz_89@mail.ucv.es.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Ortiz-Ibáñez
authors.affiliation: Musculoskeletal Sarcoma Unit, La Fe University and Technologic Hospital, Valencia, Spain. joseamayacot@gmail.com.
authors.forename: José V
authors.initials: JV
authors.lastname: Amaya
authors.affiliation: Musculoskeletal Sarcoma Unit, La Fe University and Technologic Hospital, Valencia, Spain. fbaixaulig@gmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Baixauli
authors.affiliation: Musculoskeletal Sarcoma Unit, La Fe University and Technologic Hospital, Valencia, Spain. mangulosa@hotmail.com.
authors.forename: Manuel
authors.initials: M
authors.lastname: Angulo
authors.affiliation: Department of Pathology, La Fe University and Technologic Hospital, Valencia, Spain. empar13@hotmail.com.
authors.forename: Empar
authors.initials: E
authors.lastname: Mayordomo-Aranda
authors.affiliation: Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain. carlos.barrios@ucv.es.
authors.forename: Carlos
authors.initials: C
authors.lastname: Barrios
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005121:Extremities / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008080:Liposarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D015996:Survival Rate