Surgery of Sarcomas

The common quality criteria for sarcoma surgery are en bloc resection, without fragmentation, and with clear margins. A percutaneous biopsy is necessary before the surgical procedure in order to adapt the extent of surgery to the histological subtype and to plan any potential preoperative treatments. For sarcomas of the extremities, advances in plastic surgery and vascular surgery have expanded the indications for limb-sparing procedures, thanks to reconstructive flaps and, if needed, vascular bypasses in cases of vascular involvement. In the case of retroperitoneal sarcomas, compartmental surgeries are now performed, removing the tumor en bloc along with adjacent organs (kidney, colon, and fascia), particularly for liposarcomas, which are the most common. Indeed, several studies have shown a threefold reduction in local recurrence risk and an improvement in overall survival compared to simple tumor resection. In contrast, the current strategy for desmoid tumors is initial surveillance, treating only those that show progression. Several retrospective and prospective studies have demonstrated that half of desmoid tumors spontaneously regress or stabilize.