Liposarcoma surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

The predominant therapy for liposarcoma is surgical resection. Adjunctive chemotherapy and radiation may be required.

• Surgery is the key treatment of non-metastasized liposarcoma.
• Tumor along with a wide margin of healthy tissue is removed to ensure that only healthy tissue is retained.
• Stage 1 liposarcomas of limbs, trunk, head and neck are treated with surgery.
• Stage 2 and 3 may require radiation and chemotherapy along with surgery.
• Following is a classification for surgical resection:^[1]

• Treatment by stage involves some basic criteria given below:^[2]

• Primary treatment is surgery.
• If the margins are cut >1 cm sparing the fascia, “care” after surgery is the adjuvant treatment.
• “Care” includes the following.:

• Rehabilitation if needed
• Medical history and physical examination every 3 – 6 months for every 2 – 3 years
• Chest imaging every 6 – 12 months
• Tumor site imaging right after surgery and then at regular intervals of time

• If the margins are cut <1 cm with the fascia, for stage 1A consider radiation therapy and “care” after treatment and for stage 1B consider radiation therapy.

• For stage 2A, radiation is given as neoadjuvant therapy followed by surgery as a primary treatment and then radiation boost as an adjuvant therapy.
• For stage 2B or 3, radiation/chemotherapy/chemoradiation are given as neoadjuvant therapy followed by surgery as a primary treatment and radiation boost or chemotherapy as an adjuvant therapy.
• For tumors which cannot be surgically resected, radiation therapy/chemoradiation/chemotherapy/isolated limb chemotherapy is given as primary treatment.

• It is followed by surgery if possible and radiation boost/chemotherapy as a follow up treatment option.
• If surgery is still not feasible, radiation/palliative chemotherapy or surgery/amputation/supportive care are the treatment options.

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