Abstract

FERNANDEZ-PALACIOS, Javier et al. Upper extremity sarcomas: review from Plastic Surgerym Department - Soft-Tissue Sarcoma Committee at Dr. Negrin Hospital. Cir. plást. iberolatinoam. [online]. 2017, vol.43, suppl.1, pp.s77-s86. ISSN 1989-2055.

Background and Objective. Upper extremity sarcomas represent just a small porcentage of all sarcomas. The anatomic characteristics of upper extremity challenge the goal of combining radicality and limb functional preservation. On the other hand, the limb root presents other features regarding dimensions and anatomy thus allowing wider resections. Moreover it is a common place for low grade sarcomas. With such premises it can be considered that the prognosis of sarcomas of this location is more favorable than those of the rest of the extremity. The aim of this study is to confirm this hypothesis, based on our own experience. Methods. During the last 10 years 131 sarcomas were operated in our Unit, 29 of them affecting the upper extremity were recruited. They were further subdivided into 2 groups according to their location: shoulder girdle (shoulder, scapula and clavicle) with 12 cases, and those arising at the limb itself (axilla, arm, forearm and hand) with 17 cases. Several variables were analyzed in both groups: gender, age, location, hystologic type, differentiation grade, presentation, extirpation regarding margins, surgical treatment, complementary therapies, local status, general status and follow - up. Results. Sarcomas of the shoulder girdle own lower grade than those of the extremity itself. They present mostly as primary cases.Wide resections were feasible and therefore the obtained margins were better than those of the other group. None of the 12 patients of this group has had neither local or general disease. Sarcomas of the extremity itself appeared more in women, with higher grades and they are seen firstly at our institution after inadequate surgical margins or as recurrences in more than half of the cases. Locoregional flap options are scarce. Three amputations and 1 shoulder disarticulation were done in this group. Five free flaps, 2 of them with osseous component, were used. Forty-seven patients received some kind of radiotherapy and 2 more patients received chemotherapy. Four deads were recorded among this group representing 24% of all cases. Conclusions. In our series the characteristics of sarcoma ot the shoulder girdle and those of the extremity itself were different. In the former primary presentations as new cases are more frequent, dedifferentiation grades were lower and resections wider resulting in lower rates of local recurrences, general disease or mortality. On the other hand, sarcomas ot the extremity appear mainly after unplanned resections as recurrencies or inadequate margins excisions. Dedifferentiation grades here are higher and resections are not as wide as in the other group. Worser results regarding local disease, general disease or mortality were here recorded.

Keywords : Sarcomas; Upper extremity.

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