The Variability in Surgical Margin Reporting in Limb Salvage Surgery for Sarcoma.

BACKGROUND

Surgical margins are a standard reported measurement in tumor surgery that has implications for functional outcome, local control, and overall survival. There is no single accepted classification, and it is unclear what form or margin reporting predominates in the sarcoma literature.

METHODS

We performed a PubMed literature search to identify articles that reported surgical margins and oncologic outcomes in limb salvage surgery for sarcoma from 1980 to 2013. We recorded the margin classification, specialty of the journal, specialty of the author, and location of the authors' institution.

RESULTS

We found that 159/448 (35%) of articles included in the study did not report surgical margins. Of the 289 papers that did include data on margins, 160 (55%) of articles used Enneking's classification. There has been an increase over time in the proportion of articles reporting surgical margins by the residual tumor (R) classification and the proportion of articles reporting margins dichotomously as "positive" or "negative."

CONCLUSIONS

We did not find a common method for reporting margins in the limb salvage sarcoma literature. Of most concern was over 1/3 of clinical reports of oncologic outcomes did not include margin status, which substantially compromises any conclusions that readers may infer about treatment success, local recurrence, or survival. We believe there should be renewed efforts to encourage use of a common surgical margin reporting system that is simple, reproducible, and prognostic.