Primary resection of soft-tissue sarcomas: yes and no

The primary tumour site is the most common origin in relapses of soft-tissue sarcomas (75%). Therefore, prevention of a relapse depends mainly on local tumour control in the primary therapeutic regimen. There are three modalities of treating children with sarcomas: surgical removal, radiation therapy and systemic chemotherapy. The aim is to reach a complete removal of the primary tumour and to preserve all vital and functionally useful structures. Under this aspect we evaluated the results of 22 patients, treated for soft-tissue sarcoma at the University Children's Hospital, Zurich, between 1989 and 1995. The age of the patients ranged between 3 and 16 years. The tumours of 11 patients were primarily resected, but in 9 patients the removal was incomplete (7 microscopically, Z macroscopically). Only 2 patients had a complete primary removal of their tumours, both being paratesticular sarcomas. In 11 patients an incisional biopsy was performed. Two of these patients had stage IV initially. Two tumours were removed completely in a second operation. Six patients did not need any further resections because of a very good response to chemotherapy. In 1 patient with unresectable tumour it was possible to remove the tumour almost completely after primary chemotherapy.

Our experience with primary chemotherapy in soft tissue sarcomas showed the following advantages: 1. The low morbidity after biopsy allows a rapid beginning of the treatment. 2. In case of a very good response to chemotherapy it is possible to avoid a second operation. 3. The information of a poor response to chemotherapy makes the decision for an extensive surgery easier. 4. The possibility of a delayed, but complete removal of a primarily unresectable tumour will be more likely after chemotherapy. 5. Only a small group of tumours should be considered for removal during a primary surgical procedure.