Outcomes in patients with popliteal sarcomas.

BACKGROUND: Soft-tissue sarcoma involving the popliteal fossa remains challenging because it is difficult to achieve wide margins with limb salvage in this location. Adjuvant therapy is frequently necessary, and limb function can be adversely affected. We reviewed our experience with these tumours.

METHODS: Our prospective tumour database served to identify all patients with popliteal sarcomas treated at the McGill University Health Centre and the Maisonneuve-Rosemont Hospital between 1994 and 2005. We assessed oncologic and functional outcomes as well as complications.

RESULTS: Our study included 18 patients (12 women and 6 men). The mean age was 54 (range 16-84) years. The mean duration of follow-up was 55 (range 4-126) months. Frequent histologic diagnoses were liposarcoma (n = 6), synovial sarcoma (n = 4) and leiomyosarcoma (n = 3). Tumour size varied from 2 to 21 cm (median 11 cm). American Joint Committee on Cancer staging was as follows: 4 patients had stage IIa disease, 3 patients had stage IIb, 10 patients had stage III and 1 patient had stage IV disease. Treatment consisted of limb salvage in 15 patients and amputation in 3. Fourteen patients had radiotherapy, 4 had chemotherapy, and 3 needed partial sciatic nerve resection. Margins were negative in 7 of 18 patients and microscopically positive in 11 patients. Complications included wound infections in 3 patients and thrombophlebitis in 2 patients. Of the patients undergoing limb-salvaging procedures, 1 experienced local recurrences after limb salvage (7%), and 5 experienced lung metastases (20%). Local recurrence was always associated with positive margins, whereas metastases occurred only in patients without local recurrence. The mean Musculoskeletal Tumor Society 1987 score was 33 (range 24-35). The mean Toronto Extremity Salvage Score results was 82.4 (range 63.8-100). At latest follow-up, 6 patients had died of disease, 1 was alive with disease, and 11 (61%) patients remained free of disease.

CONCLUSION: Despite the high rate of microscopically positive margins, the local recurrence rate was 7%. Amputation did not prevent death. We found function to be good to excellent in most patients who had limb-salvaging surgery.