Limb-sparing surgery combined with local inactivation by ablation improves local control in soft-tissue sarcomas : a comparative study with long-term follow-up.

Abstract

Aims: Soft-tissue sarcoma (STS) is a rare, aggressive malignancy with a high risk of recurrence when invading surrounding structures, and the optimal treatment strategy for safe surgical margins is still unclear. This study aimed to evaluate the safety and efficacy of combined local inactivation by ablation in STS during limb-sparing surgery in high-risk STS patients.

Methods: A retrospective cohort study was conducted on 44 patients between 1 January 2018 and 31 December 2022, at a tertiary medical centre. The patients were divided into two groups based on whether combined microwave in situ ablation (MWA) was performed during surgery (MWA group, n = 24 vs Control group, n = 20). The two groups were compared for postoperative complications, local disease-free survival (DFS), overall survival (OS), and progression-free survival (PFS).

Results: At the last follow-up, 12 patients in the Control group and eight patients in the MWA group experienced local recurrence. The MWA group showed longer local DFS than the Control group (48.02 (SD 4.70), 95% CI 38.81 to 57.23 vs 33.91 (SD 6.54), 95% CI 21.10 to 46.71; p = 0.047). Postoperative complications showed no significant difference (MWA: 33.3% vs Control 25%, p = 0.143). No significant differences were observed in the median OS (MWA: 53.10 (SD 6.91), 95% CI 39.55 to 66.75) compared with Control (58.30 (SD 4.66), 95% CI 49.16 to 67.44; p = 0.512) and median PFS (MWA: 16.67 (SD 3.75), 95% CI 9.32 to 23.97) compared with Control (12.62 (SD 5.88), 95% CI 1.10 to 24.09; p = 0.691) between the two groups.

Conclusion: The combined in situ ablation inactivation in high-risk STS during limb-sparing surgery can improve local tumour control and prolong local disease-free survival.