Treatment of Soft-Tissue Sarcoma Should Be Centralised

Abstract

New concepts regarding surgical margins and new modalities of preoperative examination make centralized care advantageous for patients with soft-tissue sarcomas. This study describes how the organizational level of surgical service and surgical technique have changed with time in southern Sweden. After reviewing all cases of soft-tissue sarcoma in the trunk and extremities registered during 1964-81, 261 patients remained for analysis. the material was divided into patients treated within or outside the Orthopaedic Oncology Group (OOG) for southern Sweden, which started in 1970. Patients treated by the OOG were separated into patients referred before and after surgery. in 1964-69, one-third (25/73) of the patients had a wide or compartmental excision at final surgery of the primary tumour compared with two-thirds (126/188) in 1970/81. Further, four-fifths (111/142) of the patients treated by the OOG finally had wide or compartmental excisions, whereas only one-third (15/46) of the patients treated outside the OOG over the same time period had obtained this type of surgery. When recorded, the tentative pre-operative diagnosis was a benign lesion in more than one-half of the patients treated outside the OOG. in two-thirds of the patients referred before surgery the biopsy and treatment, a wide or compartmental excision, were combined into one surgical procedure. Over the years the number of patients referred increased. During 1980-81, 35 of 38 patients with soft-tissue sarcomas were referred to the OOG: 11 before any biopsy, 14 after a malignant cytodiagnosis and 10 following marginal excisions.