Soft tissue sarcomas of the distal lower extremities: A single-institutional analysis of the prognostic significance of surgical margins in 120 patients

Soft tissue sarcomas (STS) arising in the distal lower extremities pose a therapeutic challenge due to concerns of functional morbidity. The impact of surgical margins on local recurrence-free survival (LRFS) and overall survival (OS) still remains controversial. The aim of this study was to identify prognostic indicators of survival and functional outcome in patients with STS of the distal lower extremities through a long-term follow-up. Between 1999 and 2014, 120 patients with STS of the foot, ankle and lower leg were treated surgically at our institution. The median follow-up was 6.3 years. The results reveal that the 5-year estimate of the OS rate was 80.0% [95% confidence interval (CI): 69.6-87.1] for the entire series. Surgical margins attained at the resection of the primary tumor did not influence OS significantly [5-year OS: RO 80.5% (69.7-87.9) vs. R1 74.1% (28.9-93.0); P=0.3181. Within the RO subgroup, negative surgical margin widths <= 1 and >1 mm led to similar outcomes, as well as <= 5 and >5 mm, respectively. In the multivariate analysis, significant adverse prognostic features included male gender and age >60 years at the time point of primary diagnosis. In conclusion, the data from this study could not underscore the long-term benefit of negative margins achieved at the resection of the primary tumor. Surgical efforts should aim at function-sparing resections when feasible with negative margins. Here, close negative margins seem to be adequate.