Analysis and risk factors of soft tissue sarcomas of the popliteal fossa

The soft tissue sarcomas of the popliteal fossa often appear to be close to neurovascular bundles and surrounded by an incomplete anatomical containment. The aim of this study was to determine the outcomes and to define the risk factors of limb salvage surgery in this difficult anatomical area. Patients & methods: 27 patients (53.3+/-15.8 y; 16/27 male) with popliteal soft tissue sarcomas were assessed. Mean follow-up was 40.9+/-33.8 months (48.5+/- 36.7 months in surviving patients). 9/27 patients were included after prior treatment elsewhere (5 after intralesional resections and 4 local recurrences). The lesions were staged IB in 8/27 patients, IIB in 17/27 and III in 2/27. Immediate amputations were performed in 7/27 patients. 15/27 patients were subjected to radiation therapy (preoperative in 6/15 cases), 8/27 patients received chemotherapy (5/8 preoperatively). Results: Overall survival and disease-free survival at 5 y was 63.0% and 59.5%. Local recurrence occurred in 2 patients. 8/27 patients developed metastatic disease after 28.9+/- 9.8 months. Survival ( p=0.397) and disease-free survival ( p=0.113) did not differ in patients after amputations vs limb salvage. Application of radiation therapy was associated with a better survival ( p=0.003). Complications related to the surgical intervention were recorded in 2/27 patients, complications related to radiation therapy occurred in 6/15 patients. Discussion: Despite being extra-compartmental, popliteal sarcomas can be treated with a high rate of limb salvage while equal safety compared to amputations is maintained. Irradiation improved survival in our patient population. In cases with involvement of neurovascular structures, preoperative down-staging with radio or chemo-therapy may prevent amputation.