What is involved in the surgical resection of angiosarcoma?

From the Guidelines

Surgical resection of angiosarcoma typically involves complete excision of the tumor with a margin of normal tissue, and may require plastic surgical reconstruction to achieve optimal outcomes 1.

Key Considerations

• The primary aim of surgery is to completely excise the tumor with a margin of normal tissue, considering the anatomical location, histopathology, and functional consequences of resection 1.
• Angiosarcoma of the breast is a particularly aggressive phenotype, with a high risk of local relapse and metastatic spread, and may require mastectomy and postoperative radiation therapy 1.
• Neoadjuvant strategies, including preoperative radiotherapy and/or systemic/regional chemotherapy, may be considered for large high-grade tumors that are borderline resectable at presentation 1.
• Lymphadenectomy is not typically carried out in the absence of clinical evidence of involvement 1.
• Close collaboration between the resectional and reconstructive surgical teams, as well as the clinical oncology team, is essential to determine the optimal timing of radiotherapy and reconstructive procedures 1.

Surgical Approaches

• Wide excisional surgery may be necessary to achieve adequate margins, and may be supplemented with neo/adjuvant radiotherapy to reduce the risk of local recurrence 1.
• Amputation may be considered in rare situations where it is the most appropriate surgical option to obtain local control and offer the best chance of cure 1.
• Breast-conserving surgery may be an option for some breast sarcomas, depending on the quality of margins and the size of the tumor and breast 1.

From the Research

Surgical Resection of Angiosarcoma

Surgical resection is a crucial component in the treatment of angiosarcoma, with the goal of achieving complete removal of the tumor. The following points highlight the key aspects involved in the surgical resection of angiosarcoma:

• Wide excision of the tumor is often necessary to ensure complete removal of the cancerous cells 2, 3, 4.
• The extent of resection is an important predictor of survival, with complete (R0) resection resulting in improved overall survival (OS) and progression-free survival (PFS) compared to microscopic or macroscopic residual tumor resection 5.
• Surgical treatment may involve en-bloc resection, which can significantly improve survival in cases of spinal angiosarcoma 6.
• Reconstruction options, such as free flap with skin graft, may be necessary after wide excision of the tumor, particularly in cases of angiosarcoma of the scalp 3.
• A multidisciplinary approach, including surgery, radiotherapy, and chemotherapy, is often necessary to achieve favorable outcomes in patients with angiosarcoma 2, 5, 4.

Key Considerations

Some key considerations in the surgical resection of angiosarcoma include:

• Achieving sufficient resection margins to control local recurrence 3.
• The role of adjuvant chemotherapy, which is still unclear, but may be beneficial in some cases 2.
• The importance of a multidisciplinary approach, which can improve patient outcomes and survival rates 5, 4.
• The need for individualized treatment plans, taking into account the specific characteristics of the tumor and the patient's overall health 2, 5.