Primary myectomy for sarcoma.

Sixteen patients with an intramuscular or intermuscular high-grade Stage-IIA soft-tissue sarcoma in the upper or lower extremity were treated by en bloc myectomy of one or several muscles without preoperative or intraoperative open biopsy. The total anatomical compartment containing the tumor, bounded by deep fascia and major intermuscular septa, as defined by the Musculoskeletal Tumor Society, was not removed. Adjunctive therapy was not given. The clinical and radiographic diagnosis of sarcoma was supported by the study of cells obtained by fine-needle aspiration in eleven patients. During a median length of follow-up of seven years (range, one to fourteen years), there was only one local recurrence. Thus, it is our experience that, in addition to deep fascia and major intermuscular septa, an uninvolved muscle fascia that has not been transgressed by an open biopsy is an adequate barrier against tumor growth or so-called skip metastases, and that with the proper indications total compartmental resection is not necessary even for a high-grade sarcoma.