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Annals of Surgical Oncology

, Volume 16, Issue 3, pp 676–686 | Cite as

Evaluation of 47 Soft Tissue Sarcoma Resection Specimens after Isolated Limb Perfusion with TNF-α and Melphalan: Histologically Characterized Improved Margins Correlate with Absence of Recurrences

  • Florian Grabellus
  • Corinna Kraft
  • Sien-Yi Sheu
  • Peter Ebeling
  • Sebastian Bauer
  • Sven Lendemans
  • Kurt W. Schmid
  • Georg Taeger
Bone and Soft Tissue Sarcomas

Abstract

Background

Isolated limb perfusion (TM-ILP) is an effective limb-sparing treatment for primarily nonresectable soft tissue sarcomas (STS). Surgical margins of STS after ILP were yet not systematically studied.

Methods

In 47 patients with nonresectable STS, TM-ILP with subsequent tumor resection was performed. Surgical margins were systematically analyzed by light microscopy using the TNM and the Enneking classification. Furthermore, margins were analyzed for tumor regression in terms of improved resectability. Results were correlated with clinical and pathological parameters.

Results

Of 47 STS, 44 were classified as high-grade (93.6%) with a median tumor size of 10.0 cm. Primary limb-salvage rate was 85.1%. According to TNM resection margins were complete in 70.2% (R0) and incomplete in 29.8% (R1 = 21.3%, R2 = 8.5%). According to Enneking, 27.7% intralesional, 42.6% marginal, 21.3% wide, 2.1% radical, and 6.4% unclassifiable margins were found. Prior surgery and/or radiotherapy significantly decreased margin quality. Ten patients with incomplete resection (three intralesional, seven marginal) had no viable tumor at the plane of dissection, which was designated as “improved margins.” Whereas those patients remained relapse free, five patients with viable tumor (not improved margins) at the resection margin had local recurrences. Poor margins were associated with local and distant recurrences and limited disease-specific survival.

Conclusion

TM-ILP is effective for achieving limb salvage. Histopathology of surgical margins demonstrates cases with so-called “improved margins” after TM-ILP, which are related to a better outcome even in intralesionally resected tumors. Improvement of margins should be further evaluated as a potential relevant prognostic parameter.

Keywords

Resection Margin Soft Tissue Sarcoma Limb Salvage Soft Tissue Sarcoma Isolate Limb Perfusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Florian Grabellus
    • 1
  • Corinna Kraft
    • 1
  • Sien-Yi Sheu
    • 1
  • Peter Ebeling
    • 2
  • Sebastian Bauer
    • 2
  • Sven Lendemans
    • 3
  • Kurt W. Schmid
    • 1
  • Georg Taeger
    • 3
  1. 1.Institute of Pathology and NeuropathologyUniversity Hospital Essen and Sarcoma Center at the West German Cancer Center, University of Duisburg-EssenEssenGermany
  2. 2.Department of Internal Medicine and Cancer ResearchUniversity Hospital Essen and Sarcoma Center at the West German Cancer Center, University of Duisburg-EssenEssenGermany
  3. 3.Department of TraumasurgeryUniversity Hospital Essen and Sarcoma Center at the West German Cancer Center, University of Duisburg-EssenEssenGermany

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