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either tertiary centers or local hospitals with appropriate
1.0 consulting. Presumably, the delay between detecting the
lump and getting treatment was short because upper limb
0.8 tumors are easily found by the patients themselves, and
even small tumors are visible in this area. However, this
0.6 study showed that even though the tumors were biopsied
incisionally, this did not result in cancer spreading or poor
survival. The patients whose tumors were incisionally
0.4 biopsied had the same outcomes with those whose
tumors were diagnosed according to the national practice
0.2 guidelines. According to the literature, the risk of residual
TIME_PERIOD=A tumor tissue is 24–60% after an unplanned surgery [10,11]
0.0 TIME_PERIOD=B and therefore confirms the fact that unplanned surgery
But still many
increases the risk of local recurrence.
[12,13]
0 200 400 600 800 1,000 1,200 1,400
patients are operated in tertiary centers without accurate
Figure 1: Soft-tissue sarcoma specific survival between the time periods; imagining and biopsy. [14,15]
Group A (green) and Group B (red)
There were many patients who had had a previous benign
after the knowledge about tumor diagnostics improved. tumor in the same location. In addition to the previous
In the latter years of the study, the number of sarcoma tumor diagnosis and treatment, the newly formed tumor
patients increased. In the year 2001 there were 8 patients should always be examined as an independent disease,
diagnosed with STS, in 2008; 19 patients and in 2009; according to the recommendations. Furthermore, we
15 patients. This likely resulted from improved knowledge found that in some cases histological evaluation was
of these tumors by primary care practitioners and never made and thus the diagnosis was delayed.
improved referral patterns to specialized units. National guidelines are still not being followed correctly.

When comparing our single institution’s STS results Sarcomas are being incisionally biopsied without
with a nationwide population based study in Finland, no appropriate imagining. A failure to implement guidelines
statistically significant differences in surgical treatment, is primarily due to the rarity of this malignancy. Only a
[5]
local recurrence, metastasis or survival were noted. STS few doctors come to face STS during their practice and
local recurrence in our series was 22% and as opposed to therefore the guidelines are not easy to remember. To
30% in earlier studies. [1] increase the awareness of tumor diagnostics, the national
guidelines should be effectively and repeatedly processed
In this study, Group B had more metastases [Figure 1] in tertiary centers. Written recommendations in the
a lower survival rate as well as a shorter survival time. Internet are not enough. Guidelines have to be introduced
We also noted that the 1st year survival was better in by personal education, lectures, and program with easy
Group A. Because this was a retrospective study, we availability to all doctors who take part in referring
were not able to analyze the effect histologic grading patients to specialized units.
on cervical. Between the years, 2000 and 2009 sarcomas
were primarily divided into 3 histologic grades: grade I REFERENCES
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grading. [6,7] Although there were only minimal differences Casali PG. Extremity soft tissue sarcoma in a series of patients treated at a single
in grading between the groups, it is notable that Grade 3. institution: local control directly impacts survival. Ann Surg 2010;251:506-11.
King DM, Hackbarth DA, Kirkpatrick A. Extremity soft tissue sarcoma
III tumors were equally prevalent in the 2 groups resections: how wide do you need to be? Clin Orthop Relat Res 2012;470:692-9.
studied: (A: 43%, B: 45%). 4. Khatri VP, Goodnight JE Jr. Extremity soft tissue sarcoma: controversial
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Group B to be more likely to have metastases with a Virkkunen P, Blomqvist C. Soft-tissue sarcomas of the upper extremity:
lower overall survival rate. After consideration of all surgical treatment and outcome. Plast Reconstr Surg 2004;113:222-30.
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Gibbs CP Jr. Multidisciplinary management of soft tissue sarcoma. Scientifi c
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