Logo of The Journal of Bone & Joint Surgery (Br)
Joint Replacement Instrumentation Limited (JRI) Ad
Quick search:        
          Advanced Search
Guest Access | Sign In
Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 2, 209-214.
doi: 10.1302/0301-620X.90B2.19601  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow My Folders
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pradhan, A.
Right arrow Articles by Smith, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pradhan, A.
Right arrow Articles by Smith, M.

Soft-tissue sarcomas of the hand

ONCOLOGICAL OUTCOME AND PROGNOSTIC FACTORS

A. Pradhan, MBChB(Hons), MBedSc, Specialist Registrar1; Y. C. Cheung, MBChB2; R. J. Grimer, FRCS(Orth), Consultant Orthopaedic Oncologist3; D. Peake, FRCR, Consultant Oncologist3; O. A. Al-Muderis, BSc(Hons), Sarcoma Unit Data Manager4; J. M. Thomas, FRCS, Consultant General Surgeon Sarcoma Unit4; and M. Smith, FRCS(Orth), Consultant Orthopaedic Surgeon5

1 Staffordshire General Hospital, Weston Road, Stafford ST16 3SA, UK.
2 Foundation Year 2, Queen’s Hospital, Belvedere Road, Burton-on-Trent DE13 0RB, UK.
3 Oncology Department Royal Orthopaedic Hospital, Birmingham B31 2AP, UK.
4 Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
5 Guy’s and St Thomas NHS Foundation Trust, Guy’s Hospital, St Thomas Street, London SE1 9RT, UK.

Correspondence should be sent to Mr R. J. Grimer; e-mail: rob.grimer{at}roh.nhs.uk

We have investigated the oncological outcome of 63 patients with soft-tissue sarcomas of the hand managed at three major centres in the United Kingdom. There were 44 males and 19 females with a mean age of 45 years (11 to 92). The three most common diagnoses were synovial sarcoma, clear cell sarcoma and epithelioid sarcoma. Local excision was carried out in 45 patients (71%) and amputation in 18 (29%). All those treated by amputation had a wide margin of excision but this was only achieved in 58% of those treated by local excision. The risk of local recurrence was 6% in those treated by amputation compared with 42% for those who underwent attempted limb salvage. An inadequate margin of excision resulted in a 12 times greater risk of local recurrence when compared with those in whom a wide margin of excision had been achieved. We were unable to demonstrate any role for radiotherapy in decreasing the risk of local recurrence when there was an inadequate margin of excision. Patients with an inadequate margin of excision had a much higher risk of both local recurrence and metastasis than those with wide margins. The overall survival rate at five years was 87% and was related to the grade and size of the tumour and to the surgical margin.

We have shown that a clear margin of excision is essential to achieve local control of a soft-tissue sarcoma in the hand and that failure to achieve this results in a high risk of both local recurrence and metastastic disease.






(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General