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Functional compartmental resection for soft tissue sarcomas.

The necessary extent of surgical resection in soft tissue sarcomas of the extremities remains controversial. In the absence of effective adjuvant therapy to prevent metastatic disease the aim of treatment is to minimize local recurrence and to preserve function. Intracompartmental soft tissue sarcomas arising entirely within a muscle compartment may be treated by a resection which preserves some innervated muscle within that compartment rather than by total compartmental resection. The functional outcome of patients with quadriceps and buttock sarcomas treated by such functional compartmental resection is reported. Thirty-seven patients whose tumours were entirely intra-compartmental, were identified from a consecutive series of 179 patients with soft tissue sarcomas of the pelvic girdle and lower limb seen at the Royal Marsden Hospital between October 1989 and April 1993. Twenty-four were still alive for assessment of range of movement, muscle strength and functional ability. Although objective limitation of movement and muscle power were identified in the majority, the level of function was either normal or only mildly impaired in the entire group. All walk independently and of those undergoing functional compartmental resection of quadriceps or buttock, eight of the nine patients employed at the time of diagnosis have returned to their previous employment. Sporting activities were more commonly affected but the majority were able to continue previous activities with minor modification such as wearing a knee support. Functional compartmental resection is associated with a satisfactory functional outcome, is not associated with an increased risk of local recurrence and patients can be reassured that they should be able to return to their previous level of activity.