- The best chance of resection with curative intent is at the time of primary presentation. Gross complete resection is the cornerstone of management. Surgery should aim to achieve macroscopically complete resection, with a single specimen encompassing the tumor and involved contiguous organs, and with microscopically positive margins minimized. This is best achieved by resecting the tumor en bloc with adherent structures, even if not overtly infiltrated.
- The extent of surgical resection depends on histologic subtype. A systematic resection of the ipsilateral kidney, colon, and psoas muscle is often required in liposarcoma, whereas a more limited resection, albeit without giving up the attempt at minimizing marginality, is required in leiomyosarcoma and other rare subtypes such as solitary fibrous tumor.
- Neoadjuvant therapies (chemotherapy, external beam radiation, or combination radiation and chemotherapy) are safe in well-selected patients and may be considered after careful review by a multidisciplinary sarcoma tumor board when the recurrence risk is high. The preferred modality is chosen based on the pattern of recurrence, chemotherapy being employed in histologies with the highest systemic risk (eg, leiomyosarcoma and high-grade dedifferentiated liposarcoma), and radiotherapy in those with the highest locoregional risk (eg, well-differentiated liposarcoma and low/intermediate dedifferentiated liposarcoma). None of the neoadjuvant/adjuvant modalities, however, has proven its value in terms of improved survival rates.