Prognostic Value of Surgical Margins for Local Recurrence in Soft Tissue Sarcoma

Abstract

Background: Soft tissue sarcoma is a rare malignant tumor with high risk of local recurrence. Surgery with negative margins is the primary treatment, but the optimal margin distance remains debated, and evidence from Indonesia is limited.

Objective: To evaluate the association of surgical margin status and distance with local recurrence in soft tissue sarcoma, and to assess the role of adjuvant radiotherapy and chemotherapy.

Methods: This retrospective cohort included 34 patients with histologically confirmed soft tissue sarcoma who underwent surgery at Dr. Soetomo General Hospital, Surabaya (2011–2020). Data collected were demographics, tumor grade, surgical margin status and distance, adjuvant therapy, and recurrence. Statistical analysis used Fisher’s Exact Test (Chi-Square when appropriate), with significance at p<0.05.

Results: Local recurrence occurred in 12 patients (35%). Positive margins had significantly higher recurrence (86%) compared to negative margins (22%, p=0.009). Margins <1 mm carried the highest recurrence risk (57%), whereas no recurrence was observed with 6–10 mm margins (p=0.049). Radiotherapy reduced recurrence in patients with close margins (<1 mm, p=0.045), while chemotherapy showed no consistent benefit.

Conclusion: Negative surgical margins with adequate distance remain the key determinant of local control in soft tissue sarcoma. Radiotherapy may provide additional protection in close margins, whereas chemotherapy has limited effect. Careful surgical planning and multidisciplinary management are crucial for improving patient outcomes.