| Abstrakt: |
Sarcomas are solid, malignant tumors of mesenchymal origin, having a high heterogeneity, with more than 100 different histological subtypes. Although rare, with an incidence of about 1% of adult neoplasms, they frequently have aggressive forms, with a more reserved prognosis compared to other more common cancers. The higher incidence, around 40%, is found in the upper and lower limbs. Creating a “high-volume” center of excellence to focus on this pathology is a logical decision to improve the outcomes and optimize resource utilization. The use of treatment standards, including surgical evidence-based ones, is a must. Decisions are made in a mandatory tumor board that includes at least one sarcoma expert. Preoperatively imaging evaluation (MRI) and biopsy – preferably the core-needle biopsy variant – are indispensable. Surgical resection with or without neoadjuvant treatment is the main therapeutic approach in non-metastasized forms. The resection is done en bloc with the biopsy tract, and must include a safety limit of at least 2 cm and, also, with uninvaded surgical margins (R0). The type of intervention is individualized to each patient, depending on the histopathological form, size and location of the tumor, ranging from extracompartmental resections to wide or marginal excision. Amputation should be avoided, if possible, because it does not bring benefits in terms of survival. Lymphadenectomy is rarely necessary, and it has a prognostic value. Clipping the tumor bed or, possibly, the residual tumor is useful for adjuvant radiation therapy. Surgical suction drainage is done routinely to avoid hematomas or postoperative seromas. [ABSTRACT FROM AUTHOR] |
