CTOS Op Ed |
The Margin Matters: Someone's life depends upon it
An ESUN Article
Editor's Note: This is the fourth in the series of Op Ed pieces written by one of the members of the Board of Directors of the Connective Tissue Oncology Society (CTOS). These Op Ed pieces are intended to address important and controversial issues in the field. The “CTOS Questions, Comments & Counterpoint” column allows readers to express their opinions in response to these Op Ed pieces. Click here to send in an opinion.
The operative margin matters. Surgical resection remains the common and central modality in the care of the sarcoma patient. Whether the tumor responds to chemotherapy, radiotherapy or newly devised bio-targeting, the primary tumor, and often metastatic sites, must be resected in order to achieve a cure. It is also known that local recurrence of a sarcoma often is a function of the quality and quantity of the margin of normal tissue removed around the cancer. Furthermore, patients that do experience a local recurrence are at increased risk of dying from their disease.
Determining the optimal margin to maintain as much function as possible while still achieving the goal of complete tumor removal is a decision that is made intra-operatively after very careful and strategic preoperative planning. Accordingly, surgical experience matters. Surgeons that do not regularly remove these rare and deadly cancers are therefore more likely to execute a well-intended, but less than optimal, cancer operation. In such circumstances, local recurrence is more likely. This risk is further compounded when sarcoma surgery is performed outside recognized sarcoma centers by a surgical team that is not familiar with tissue handling protocols necessary to perform the latest molecular tests on the removed tumor. Furthermore, an inexperienced pathologist may also have a very difficult time establishing the correct diagnosis and margin status.
As has been emphasized previously in these editorials, patients and families must be made aware of the differences advantaged and disadvantaged by where they initiate their sarcoma care. While surgery may be only one but critical component of the treatment plan in some cases, it must be integrated into the overall care of the sarcoma patient. Appropriate surgical management not only affects the quality but the quantity of life for the patient afflicted with sarcoma. The margin of error, like the surgical margin, must be optimized. Someone’s life depends upon it.
V4N4 ESUN Copyright © 2007 Liddy Shriver Sarcoma Initiative.