A Rare and Complex Surgical Procedure

Sarcomas are rare and widespread tumors that affect 4,000 people in France each year. In nearly 90% of cases, the diagnosis is made at a stage when there are no metastases. Surgery aimed at removing the tumor without tumor invasion and with a margin of healthy tissue in all directions is the cornerstone of curative treatment.

Planning this surgery requires a great deal of expertise because, given the unique nature of each patient, it must balance the preservation of bodily integrity with impeccable oncological outcomes. As with all rare diseases, receiving care from the outset at a specialized center reduces the risk of recurrence and improves the chances of a cure.

Care Beginning at the First Suspicion of Sarcoma

In the field of sarcomas, the shortcomings of an inappropriate initial surgical procedure are difficult to compensate for with adjuvant therapy, regardless of how aggressive it may be. The quality of the initial diagnostic process is critical. The latest European guidelines for managing suspected sarcoma can be summarized in four steps that ensure optimal subsequent treatment.

• The need for an adequate initial radiological evaluation (while imaging in cases of suspected sarcoma is not intended to be diagnostic, it remains essential for a locoregional assessment of the disease, using an MRI or CT scan)
• The need for a systematic biopsy in children under 18 years of age, and in adults in cases of deep lesions (i.e., beneath a muscular aponeurosis) regardless of its size, and in adults with superficial lesions (i.e., supra-aponeurotic) if they are larger than 3 cm. This biopsy must be performed using a large-gauge needle with a coaxial technique to avoid contaminating the puncture site.
• The need for a systematic pathological review by an expert pathologist, which allows for a diagnostic correction in 25% of cases when a review is requested due to uncertainty and in 9% of cases during a systematic review
• The need to discuss any treatment during a multidisciplinary team meeting at a center specializing in sarcomas. The treatment strategies proposed to the patient must be established through consensus among specialists from various disciplines (surgery, radiation oncology, medical oncology, imaging, and pathology), all of whom have expertise in the field of sarcomas.

Teamwork

Since sarcomas can affect any organ, their management requires a wide range of skills and must be based on collaboration among specialists from the various relevant disciplines. Dr. Charles Honoré coordinates, along with his colleagues, the surgical management of all patients with sarcoma, regardless of age. Gustave Roussy directly provides surgical treatment for all patients with visceral or soft-tissue sarcomas, regardless of their location, whether they are primary tumors or recurrences.

A partnership with the Kremlin-Bicêtre University Hospital and the Marie Lannelongue Hospital in Plessis-Robinson ensures the care of patients with bone, cardiovascular, or thoracic sarcomas. The goal of surgical care at Gustave Roussy is to establish, through collaboration among specialists from various disciplines, a personalized treatment plan that takes into account the unique characteristics of each patient.