Benefits Associated With Early Diagnosis and Treatment of Soft Tissue Sarcomas of the Foot and Ankle

Soft tissue sarcomas arising in the foot and ankle are often misdiagnosed, resulting in excision without adequate preoperative staging or surgical margins. The goal of the present study was to review a case series of soft tissue sarcomas of the foot and ankle with attention directed at unplanned excisions of sarcomas. An unplanned excision means that a patient either underwent an inadequate preoperative workup or the preoperative workup indicated a benign entity, resulting in surgical resection. We retrospectively analyzed the medical records of 10 patients with sarcomas of the foot and ankle treated at our institution. All soft tissue sarcomas were excised with the widest margin possible without any major bone or neurovascular resection to allow for preservation of the foot. All patients were followed up for a minimum of 8 months to assess pain, function, and complications. The patients were followed up for an average of 22.4 (range 8 to 44) months. Of the 10 patients, 6 had undergone preoperative magnetic resonance imaging without contrast and the sarcomas were read as benign or cystic masses. Two patients had undergone preoperative magnetic resonance imaging with contrast, and these scans were also misread. Despite having undergone previous unplanned surgery, none of these sarcomas had recurred after repeat resection with a wider margin at a mean follow-up of 22.4 (range 8 to 44) months. At the last follow-up point, 8 patients were alive without evidence of disease. Minor complications included lymph edema in 1, stress fracture in 1, and wound infection in 1 that resolved. Preoperative MRI with contrast is recommended before resecting any soft tissue masses of the foot and ankle. In the event of an unplanned excision of a soft tissue sarcoma, the patient should be referred to an orthopedic oncologist for definitive surgery to optimize the oncologic and functional results. In the present retrospective analysis, previous intervention did not seem to affect the prognosis, including local recurrence, distant metastasis, disease-free interval, and functional outcomes.