Surgical management of soft tissue sarcoma

Soft tissue sarcomas (STS) are a heterogeneous group of tumours and surgery is the principal treatment. The majority occur in the limbs and trunk wall and this article refers to management of these anatomical sites. STS is managed within a specialist multidisciplinary team and an individualized treatment plan is produced for each patient. Histological, anatomical and patient factors will all influence the strategy. In localized disease, the surgical aim is to achieve a wide excision with negative margin and preserve function. Radiotherapy may be indicated to reduce the risk of local recurrence and can be given pre- and/or post-operatively. Planned marginal excision combined with radiotherapy is an acceptable approach in order to preserve critical structures. Neo-adjuvant radiotherapy can reduce tumour burden and improve operability. However, amputation is sometimes the only treatment option. Reconstructive surgery may be required to achieve wound healing and restore function. The approach to management of local recurrence is much the same as for primary disease. Advanced disease is predominantly treated by systemic therapy but metastatectomy is utilized in some circumstances. Follow-up is required to monitor for recurrence, metastasis and complications of treatment.