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Wider surgical margins may not mean better cancer control

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Wider surgical margins may not mean better cancer control

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It's a question that surgeons often face: How much surrounding healthy tissue should they take out when removing a patient's cancer to be sure it is fully eliminated? Removing more can sacrifice nearby nerves, blood vessels, tendons and even joints, with lasting effects on quality of life.

A new study led by UC Davis researchers finds that in at least one type of cancer, control may be achieved with much narrower margins than previously thought.

Until now, surgeons have had no scientific evidence on the optimal surgical margins for pediatric patients with non-rhabdomyosarcoma soft tissue sarcomas (NRSTS). In this first large prospective clinical trial, scientists evaluated the risk of local cancer recurrence after surgical and chemoradiation therapies for nonmetastatic NRSTS in children and young adult patients.

The trial (ARST0332) by the Children's Oncology Group showed that close surgical margins as narrow as a millimeter—less than one-tenth of the traditional surgical margin—would preserve healthy tissue and maintain a low risk of recurrence. The findings are published today in JAMA Surgery.

"When we remove a tumor, our goal is to leave no cancer behind. So, when we operate on a child or young adult with soft tissue sarcomas, we ask how surgically aggressive we need to be in obtaining this negative margin?" said UC Davis Health orthopedic surgeon R. Lor Randall, the study's senior author.

Randall specializes in pediatric oncology and is The David Linn Endowed Chair for Orthopaedic Surgery.


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