Surgical Strategy

Surgical Strategy

A therapeutic strategy that includes operative treatment, chemotherapy, and radiation therapy can be devised. The relationship between the stage of the tumor and the prognosis is clear, but at the present time the stage plays only a remote role in decisions regarding operative management especially with the advent of effective preoperative and postoperative chemotherapy and radiation therapy. Thus, with respect to decisions regarding the operative procedure, the anatomical extent of the tumor is more crucial than the stage of the tumor. The operative procedure to be carried out in a particular patient become so individualized in relation to the location, size, anatomical extent, and characteristics of the lesion.

The type of resection can be defined as intralesional (curettage or debulking), marginal (through the pseudocapsule or perilesional zone surrounding the tumor), wide (in normal tissue outside the pseudocapsule), or radical (the entire compartment).

 

Margin

Description of Tumor

Intralesional

Stage-1 and stage-2 benign bone tumors (curettage alone)

Stage-3 benign bone tumors
(extended curettage and adjuvant local measures)

Marginal

Benign non-infiltrating soft-tissue tumors,

Stage-3 benign bone tumors with adjuvant treatments.

Recurrent stage-2 and stage-3 benign bone tumors.

Selected low and high-grade sarcomas after successful preoperative adjuvant chemotherapy and radiation therapy.

Wide

Recurrent stage-3 benign bone tumors,

most low and high-grade bone and soft-tissue sarcomas with or without adjuvant treatment

Radical

Recurrent sarcomas

Displaced pathological fractures through bone sarcomas

Sarcomas of indeterminate extent as ascertained by imaging