Marimuthu, S (2008) A Study on limb sparing surgery on extremity soft tissue sarcoma. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION : Soft tissue sarcomas are the most frequent sarcomas. They are a rare and heterogeneous group of tumors that arise from the supporting extra skeletal tissues (i.e., muscle, fascia, nerve, connective, fibrous, and fatty tissues. Although soft tissues comprise 75% of the average body weight, these neoplasms represent less than 1% of all adult and 15% of pediatric malignancies. Soft tissue sarcomas are a disease of adulthood, occurring most commonly in persons between 30 and 60 years of age. The sole exception is rhabdomyosarcoma, which occurs in young children. Each of the various soft tissue sarcomas has a unique morphology, biological behavior, and prognosis. However, like bone sarcomas, they all share certain biological and behavioural characteristics. The clinical, radiographic, and surgical management of most soft tissue sarcomas is identical, regardless of histogenesis. The treatment of soft tissue sarcoma has become multidisciplinary, as advances in biology, imaging, surgery, chemotherapy and radiotherapy have improved the outlook for these patients who have these malignancies. AIM : 1. To study the incidence of soft tissue sarcoma in our institution. 2. To study the rate of limb sparing surgery and amputations. 3. To study age distribution and sex incidence. 4. To study the presentations of soft tissue sarcoma on diagnosis. 5. To study stage of the disease at presentation. 6. To study the incidence of various pathological types. 7. To study the surgical management, reconstruction techniques, complications and their management. 8. To study the functional outcome after limb sparing surgery. 9. To study the oncological outcome after limb sparing surgery. CONCLUSION : Soft tissue sarcomas are the most frequent sarcomas. They are a rare and heterogeneous group of tumors representing 1.64% of all adult malignancies in this series. They are a disease of adulthood, occurring most commonly in persons between 30 and 60 years of age. Incidence in male is lower (male: female ratio – 1.5:1) in this series than reported in other series (ratio 4:1) In this study, 81% of patients are suitable for limb sparing surgery and 19% of patients required amputation. This somewhat higher rate of amputation compared to international series is due to large tumor size and late presentation of our patients. In this study, pain is the symptom that draws the patient to seek medical attention and most of the swellings are more than 5 cm in size. So, any soft tissue mass in an adult that is symptomatic or enlarging, any mass that is larger than 5 cm or any new mass that persists beyond 4 weeks is should be considered as soft tissue sarcoma and investigated definitively. Evaluation for metastatic disease in the lungs should be done once a soft tissue sarcoma is diagnosed since one third of patients are metastatic at presentation in this study comparable to other studies. 84% of patients had T2b tumor that is deep tumor with size of more than 5 cm. Liposarcoma is the commonest histology comparable to other studies. In comparison with preoperative histology, there is 26% of discordance rate comparable to international series. Limb-sparing surgery is now the standard of care for bone and soft tissue sarcomas of the extremities and is performed in approximately 90% of all cases. All patients must be considered and evaluated for limb-sparing surgery, and the decision to proceed with an amputation should be made on a case-by-case basis. Such decisions are based on local anatomic considerations, tumor grade and stage, and consideration of the functional and psychological impact of the procedure.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | limb sparing surgery ; extremity ; soft tissue ; sarcoma. |
| Subjects: | MEDICAL > Surgical Oncology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 25 Jul 2017 03:29 |
| Last Modified: | 25 Jul 2017 03:29 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2109 |
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