• Satoshi Tsukushi, Yoshihiro Nishida, Hiroshi Urakawa, Eisuke Arai, Eiji Kozawa, and Naoki Ishiguro.
• Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan. s-tsuku@med.nagoya-u.ac.jp
• Arch Orthop Trauma Surg. 2013 Apr 1;133(4):481-6.

BackgroundWhether to preserve or sacrifice critical structures (bone, major vessels and major nerves) adjacent to soft tissue sarcomas is still controversial. Referring to characteristic imaging and intraoperative findings, we perform planned preservation surgery for these critical structures. The aim of this study was to investigate the clinical outcome of soft tissue sarcomas adjacent to critical structures and to validate this procedure.MethodsOf 202 cases of soft tissue sarcomas surgically treated at our department of orthopedic surgery from 2004 to 2010, 57 cases (28 %) whose tumors were adjacent to the critical structures were studied. There were 36 men and 21 women. In 32 cases critical structures were preserved, and in 25 resected together with the tumor. The oncological outcome and histological surgical margin were analyzed.ResultsThe overall survival and local recurrence-free survival rates at 5 years were 75.9 and 83.2 %. In 26 of the 32 (81 %) preserved cases histologically the surgical margin was negative, and in 17 (53 %) radiotherapy could be avoided. Neither overall survival (p = 0.9669) nor local recurrence-free survival (p = 0.7819) differed significantly between two groups.ConclusionsWhen soft tissue sarcomas are located adjacent to bone or major vessels, by meticulously detaching the periosteum or neurovascular sheath referring to characteristic imaging and intraoperative findings, a histologically negative surgical margin can be achieved in the majority, allowing avoidance of postoperative radiotherapy. Planned preservation surgery provided no significant adverse effect on survival or local recurrence rates, validating this procedure.

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