Extremity epithelioid sarcoma. Amputation vs local resection
P. W. Whitworth, R. E. Pollock, P. F. Mansfield, J. Couture and M. M. Romsdahl
Department of General Surgery, University of Texas M. D. Anderson Cancer Center, Houston 77036.
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.
