Space sarcomas: Extra compartmental soft tissue tumors of the lower extremities a systematic approach to sarcomas of the femoral triangle sartorial canal and popliteal space

Background: Extra-compartmental soft tissue sarcomas may grow in virtual spaces in close proximity to major neurovascular structures and thus, require a complex resection. We analyzed the general principles by which these resections are planned. Methods: We retrospectively analyzed 53 patients with sarcomas located in the femoral triangle (15), sartorial canal (16), and the popliteal fossa (22). These lesions were grouped into three categories based on involvement of spatial structure; neurovascular involvement =13, musculofascial involvement = 19 and no involvement =11. Results: Limb sparing surgery was feasible in lesions that had either no structural or musculofascial involvement. Amputation, however, was required in 3 of 13 patients with neurovascular involvement because of gross involvement of the surrounding tissues. Overall, limb sparing was feasible in 94% (50 of 53 patients). The 2-and 5-year local recurrence rates were 10% and 14%, respectively. Five-year survival was 88%. Conclusions: Limb sparing resection of space sarcomas is feasible in the majority of extra-compartmental sarcomas by utilizing a systematic approach which emphasizes specific planes of resection.