Sixteen patients with an intramuscular or intermuscular high-grade
Stage-IIA soft-tissue sarcoma in the upper or lower extremity were treated
by en bloc myectomy of one or several muscles without preoperative or
intraoperative open biopsy. The total anatomical compartment containing the
tumor, bounded by deep fascia and major intermuscular septa, as defined by
the Musculoskeletal Tumor Society, was not removed. Adjunctive therapy was
not given. The clinical and radiographic diagnosis of sarcoma was supported
by the study of cells obtained by fine-needle aspiration in eleven
patients. During a median length of follow-up of seven years (range, one to
fourteen years), there was only one local recurrence. Thus, it is our
experience that, in addition to deep fascia and major intermuscular septa,
an uninvolved muscle fascia that has not been transgressed by an open
biopsy is an adequate barrier against tumor growth or so-called skip
metastases, and that with the proper indications total compartmental
resection is not necessary even for a high-grade sarcoma.