SURGERY FOR SOFT TISSUE SARCOMA: PROPOSAL OF A NEW CLASSIFICATION FOR EXCISION BY THE FRENCH COOPERATIVE GROUP FOR SOFT TISSUE SARCOMA (STS)

Stöckle E, Bonvalot S, Depadt G, Cuisenier J, Verhaeghe JL, Lorimier G, Monticelli J, Rivoire M, Martel P, Houvenaeghel G, Goin F, Coindre JM, Bui BN from the French Cancer Center Sarcoma Group (French Federation of Anticancer Centers, Paris, France)

Introduction: Surgeons tend to overestimate the amount of excision of STS when using terms of the Enneking’s classification (compartmental, large, or marginal excision) as evidenced by remaining tumors on pathological slides in half of the patients when referred after alleged complete excision. More precise definitions of surgery of STS are needed in the era of multimodality treatment.

Methods: 1. During the FNCLCC group meeting in 11.1995, 80 operative forms have been analyzed for terms describing surgery of STS. Technical description showed to be usually complete, but tumor description and definitions of margins were poorly done. 2. New terms of surgery were established, with the goal to describe objectively what the surgeon saw and made during operation. Terms like « tumor seen », suggesting a close dissection near the tumor, allowed precise description by the surgeon without minimizing his effort to excise the tumor. Other terms were included in the check-list : « efraction of tumor, quality or amount of smallest margin, complementary excision at suspect margin, completeness of excision ». 3. At the same time, pathologists were asked to limit pathological reports to terms describing the tumor situation, but not to interprete quality of surgery. 4. Quality of surgery was expressed after confrontation between surgery and pathology, preferentially at staff meeting. Three types of resection (R) were defined: R0 = in sano, R1 = ease. 5. The new definitions were applied during a 15 months period.

Results: At analysis at the second group meeting in 1997 feasibility of this approach was good showing almost good confrontation between 176 operative forms and pathology. Difficulties were seen for fibromatosis and reexcisions. Complementary terms have been added at the second group meeting, the study still going on with a new focus scheduled at the fourth group meeting in June 1999. The whole classification and final results will be presented.

Conclusion: The proposed new classification of surgery for STS is feasible and hopefully a better contribution in optimizing multidisciplinary treatment of STS.