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Extremity Epithelioid Sarcoma: Amputation vs Local Resection

Extremity Epithelioid Sarcoma: Amputation vs Local Resection Abstract • Amputation has traditionally been advised for extremity epithelioid sarcoma because of its pattern of innocuous presentation and relentless soft-tissue and nodal metastasis. To assess the role of amputation in extremity epithelioid sarcoma, we reviewed our experience with 42 patients treated between 1961 and 1986. On presentation with localized primary tumor (n = 18), nine of 11 patients who underwent wide local excision and four of six patients who underwent excisional biopsy were free of disease, and one patient who underwent amputation died. After presentation with localized recurrence (n = 12), four of six patients who underwent wide local excision and two patients who underwent excisional biopsy were free of disease; three other patients who underwent wide local excision had margins that tested positive on pathologic examination, of whom one was free of disease; one patient who underwent amputation died of disease. On presentation with regional metastasis (n = 12), only one of five patients who underwent wide local excision and one of seven patients who underwent amputation were free of disease. Primary amputation offered no apparent overall survival benefit to patients presenting with regional metastasis. The favorable outcome after local resections for localized disease indicates that wide local excision with margins that test negative on pathologic examination is preferable to radical amputation in these patients. (Arch Surg. 1991;126:1485-1489) References 1. Prat J, Woodruff JM, Marcove RC. Epithelioid sarcoma: an analysis of 22 cases indicating the prognostic significance of vascular invasion and regional lymph node metastasis . Cancer . 1978;41:1472-1487.Crossref 2. Enzinger FM. Epithelioid sarcoma: a sarcoma simulating a granuloma or a carcinoma . Cancer . 1970;26:1029-1041.Crossref 3. Rosenberg AE, Schiller AL. Soft tissue sarcomas of the hand . Hand Clin . 1987;3:247-261. 4. Hoopes JE, Graham WP, Shack BR. Epithelioid sarcoma of the upper extremity . Plast Reconstr Surg . 1985;75:810-813.Crossref 5. Wevers AC, Kroon BBR, Albus-Lutter CE, Gortzak E. Epithelioid sarcoma . Eur J Surg Oncol . 1989;15:345-349. 6. Chase DR, Enzinger FM. Epithelioid sarcoma: diagnosis, prognostic indicators, and treatment . Am J Surg Pathol . 1985;9:241-263.Crossref 7. Bos GD, Pritchard DJ, Reiman H, Dobyns JH, Ilstrup DM, Landon GC. Epithelioid sarcoma: an analysis of fifty-one cases . J Bone Joint Surg Am . 1988;70:862-870. 8. Bryan RS, Soule EH, Dobyns JH, Pritchard DJ, Linscheid RL. Primary epithelioid sarcoma of the hand and forearm: a review of thirteen cases . J Bone Joint Surg Am . 1974;56:458-465. 9. SAS Institute Inc. SAS User's Guide: Statistics, Version 5 Edition . Cary, NC: SAS Institute Inc; 1985:956. 10. Chauveau D, Julien J, Pagny JY, et al. Epithelioid sarcoma of soft tissues: a case of extrarenal renin-secreting tumour . J Hum Hypertens . 1988;2:261-264. 11. Shimm DS, Suit HD. Radiation therapy of epithelioid sarcoma . Cancer . 1983;52:1022-1025.Crossref 12. Sugarbaker PH, Auda S, Webber BL, Triche TJ, Shapiro E, Cook WJ. Early distant metastases from epithelioid sarcoma of the hand . Cancer . 1981;48:852-855.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Extremity Epithelioid Sarcoma: Amputation vs Local Resection

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1991.01410360055009
Publisher site
See Article on Publisher Site

Abstract

Abstract • Amputation has traditionally been advised for extremity epithelioid sarcoma because of its pattern of innocuous presentation and relentless soft-tissue and nodal metastasis. To assess the role of amputation in extremity epithelioid sarcoma, we reviewed our experience with 42 patients treated between 1961 and 1986. On presentation with localized primary tumor (n = 18), nine of 11 patients who underwent wide local excision and four of six patients who underwent excisional biopsy were free of disease, and one patient who underwent amputation died. After presentation with localized recurrence (n = 12), four of six patients who underwent wide local excision and two patients who underwent excisional biopsy were free of disease; three other patients who underwent wide local excision had margins that tested positive on pathologic examination, of whom one was free of disease; one patient who underwent amputation died of disease. On presentation with regional metastasis (n = 12), only one of five patients who underwent wide local excision and one of seven patients who underwent amputation were free of disease. Primary amputation offered no apparent overall survival benefit to patients presenting with regional metastasis. The favorable outcome after local resections for localized disease indicates that wide local excision with margins that test negative on pathologic examination is preferable to radical amputation in these patients. (Arch Surg. 1991;126:1485-1489) References 1. Prat J, Woodruff JM, Marcove RC. Epithelioid sarcoma: an analysis of 22 cases indicating the prognostic significance of vascular invasion and regional lymph node metastasis . Cancer . 1978;41:1472-1487.Crossref 2. Enzinger FM. Epithelioid sarcoma: a sarcoma simulating a granuloma or a carcinoma . Cancer . 1970;26:1029-1041.Crossref 3. Rosenberg AE, Schiller AL. Soft tissue sarcomas of the hand . Hand Clin . 1987;3:247-261. 4. Hoopes JE, Graham WP, Shack BR. Epithelioid sarcoma of the upper extremity . Plast Reconstr Surg . 1985;75:810-813.Crossref 5. Wevers AC, Kroon BBR, Albus-Lutter CE, Gortzak E. Epithelioid sarcoma . Eur J Surg Oncol . 1989;15:345-349. 6. Chase DR, Enzinger FM. Epithelioid sarcoma: diagnosis, prognostic indicators, and treatment . Am J Surg Pathol . 1985;9:241-263.Crossref 7. Bos GD, Pritchard DJ, Reiman H, Dobyns JH, Ilstrup DM, Landon GC. Epithelioid sarcoma: an analysis of fifty-one cases . J Bone Joint Surg Am . 1988;70:862-870. 8. Bryan RS, Soule EH, Dobyns JH, Pritchard DJ, Linscheid RL. Primary epithelioid sarcoma of the hand and forearm: a review of thirteen cases . J Bone Joint Surg Am . 1974;56:458-465. 9. SAS Institute Inc. SAS User's Guide: Statistics, Version 5 Edition . Cary, NC: SAS Institute Inc; 1985:956. 10. Chauveau D, Julien J, Pagny JY, et al. Epithelioid sarcoma of soft tissues: a case of extrarenal renin-secreting tumour . J Hum Hypertens . 1988;2:261-264. 11. Shimm DS, Suit HD. Radiation therapy of epithelioid sarcoma . Cancer . 1983;52:1022-1025.Crossref 12. Sugarbaker PH, Auda S, Webber BL, Triche TJ, Shapiro E, Cook WJ. Early distant metastases from epithelioid sarcoma of the hand . Cancer . 1981;48:852-855.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Dec 1, 1991

References