Unexpected resection of soft-tissue sarcoma. More mutilating surgery, higher local recurrence rates, and obscure prognosis as consequences of improper surgery.

Sixteen referred patients were reviewed after excision of an unexpected soft-tissue sarcoma of the extremities. Eight tumors were located in the muscle deep to the fascia, and 8 lesions exceeded the size of 5 cm. The lack of awareness by the primary physician towards the possibility of a malignant lesion was striking, although 11 of 16 tumors presented as a newly formed mass. No imaging studies were done in 11 patients. Fine needle biopsy was unsuccessfully performed in 3 patients. Eleven lesions (63%) were high-grade. Resection margins were intralesional in 12 (75%) and marginal in 4 (25%) patients. Surgical oncologic rules were disregarded in 7 cases, including opening of probably uninvolved joints. Postoperative magnetic resonance imaging (MRI) scans showed a poor negative predictive value for residual tumor. Repeated resection, including three amputations, revealed residual tumor in 10 patients (63%). Four patients received adjuvant local radiation, with additional chemotherapy in 2 of them. At an average follow-up of 4.5 years (range 15-149 months), 4 patients (25%) had developed distant metastases with a local recurrence in 3 (19%). There was one tumor-related death (6%). Physicians' alertness towards the possible malignancy of an enlarging mass cannot be overemphasized. Evaluation by adequate imaging techniques, biopsy, and definitive resection and reconstruction should be performed by an oncologically trained orthopaedic surgeon. Inadequate primary excision leads to a high local recurrence rate and more mutilating surgery and obscures the long-term prognosis.