Surgical resection of retrohepatic inferior vena cava leiomyosarcoma without vascular reconstruction: case report.

Inferior vena cava leiomyosarcoma (IVCL) is a rare malignant mesenchymal tumor. Surgical treatment is a challenge because it must combine free surgical margins with vascular reconstruction, using prosthetic or autologous grafts, primary suture, or simple ligation without vein reconstruction. The ligation option is possible thanks to the slow growth of the tumor, allowing collateral venous circulation to develop. We present a case of an IVCL treated with radical resection without vascular reconstruction. The patient was a 48-year-old female with abdominal pain in the right upper quadrant, asthenia, and postprandial dyspeptic symptoms. Abdominal tomography revealed a mass with an expansive formation located in the infrahepatic segment of the inferior vena cava and reduced vessel lumen. During surgery, vein clamping did not provoke hemodynamic repercussions, suggesting sufficient collateral circulation formation. It was decided to perform a radical resection of the entire portion of the retrohepatic vena cava and ligate the vena cava without vascular reconstruction. The patient recovered without complications.

Ressecção cirúrgica de leiomiossarcoma de veia cava inferior retro-hepática sem reconstrução vascular: relato de caso / Surgical resection of retrohepatic inferior vena cava leiomyosarcoma without vascular reconstruction: case report

Resumo O leiomiossarcoma de veia cava inferior (LVCI) é um raro tumor maligno mesenquimal. Seu tratamento cirúrgico é um desafio, pois necessita combinar margens cirúrgicas livres com reconstrução vascular, usando prótese ou enxerto autólogo, sutura primária ou ligadura simples sem reconstrução da veia. A ligadura é possível graças ao lento crescimento do tumor, permitindo o desenvolvimento de circulação venosa colateral. Apresentamos um caso de LVCI tratado por ressecção radical sem reconstrução vascular. Paciente feminina, 48 anos, com dor abdominal em hipocôndrio direito, astenia e sintomas dispépticos pós-prandiais. Tomografia de abdome revelou massa de formação expansiva localizada no segmento infra-hepático da veia cava inferior com redução da luz do vaso. Na cirurgia, o clampeamento da veia não indicou repercussões hemodinâmicas, sugerindo formação de circulação colateral suficiente. Decidiu-se pela ressecção radical em toda a porção da veia cava retro-hepática e ligadura da veia cava sem reconstrução vascular. A paciente evoluiu sem intercorrências.

Abstract Inferior vena cava leiomyosarcoma (IVCL) is a rare malignant mesenchymal tumor. Surgical treatment is a challenge because it must combine free surgical margins with vascular reconstruction, using prosthetic or autologous grafts, primary suture, or simple ligation without vein reconstruction. The ligation option is possible thanks to the slow growth of the tumor, allowing collateral venous circulation to develop. We present a case of an IVCL treated with radical resection without vascular reconstruction. The patient was a 48-year-old female with abdominal pain in the right upper quadrant, asthenia, and postprandial dyspeptic symptoms. Abdominal tomography revealed a mass with an expansive formation located in the infrahepatic segment of the inferior vena cava and reduced vessel lumen. During surgery, vein clamping did not provoke hemodynamic repercussions, suggesting sufficient collateral circulation formation. It was decided to perform a radical resection of the entire portion of the retrohepatic vena cava and ligate the vena cava without vascular reconstruction. The patient recovered without complications.

Lipossarcoma Bem Diferenciado do Retroperitônio com Desdiferenciação e Múltiplas Recidivas: Relato de Caso / Well-Differentiated Liposarcoma of the Retroperitoneum with Dedifferentiation and Multiple Recurrences: Case Report / Liposarcoma Bien Diferenciado de Retroperitoneo con Desdiferenciación y Múltiples Recurrencias: Informe de Caso

Introdução: Os lipossarcomas retroperitoneais são neoplasias mesenquimais raras, sendo mais comuns os bem diferenciados e os desdiferenciados. O subtipo bem diferenciado pode sofrer desdiferenciação para tumores de maior grau. São neoplasias difíceis de tratar cirurgicamente, pois apresentam altas taxas de recorrência local, alguns subtipos podem metastizar e são pouco sensíveis à radioterapia e à quimioterapia. Relato do caso: Paciente feminina, 45 anos, apresentou dor abdominal e massa abdominal palpável em 2017. Foi submetida à ressecção de lipossarcoma bem diferenciado de retroperitônio, sem intercorrências. Em 2020, manifestou dor abdominal e perda ponderal. A tomografia mostrou múltiplas massas volumosas abdominais, com biópsia sugestiva de lipossarcoma desdiferenciado. Foi submetida à radioterapia neoadjuvante e, em seguida, à ressecção cirúrgica das massas e ileocolectomia direita. Em 2022, apresentou quadro sugestivo de obstrução intestinal, sendo submetida à laparotomia que evidenciou intenso bloqueio de alças intestinais, fístula duodenal, tumor retroperitonial e peritonite fecal. Procedeu-se à ressecção de neoplasia retroperitoneal, ileostomia e rafia de fístula. O histopatológico mostrou lipossarcoma desdiferenciado recidivado. A paciente evoluiu com complicações operatórias e infecciosas, necessitando de cuidados intensivos e antibioticoterapia. Após melhora clínica, recebeu alta com dieta enteral e segue em acompanhamento ambulatorial. Conclusão: O lipossarcoma de retroperitônio pode sofrer desdiferenciação, recidivas multifocais e múltiplas recorrências, necessitando de várias abordagens cirúrgicas, o que aumenta a morbidade e o risco de complicações. A cirurgia com margens amplas continua sendo a principal modalidade terapêutica.

ABSTRACT Introduction: Retroperitoneal liposarcomas are rare mesenchymal neoplasms, with well-differentiated and dedifferentiated liposarcomas being most common. The well differentiated subtype can undergo dedifferentiation to higher grade tumors. These are difficult neoplasms to treat surgically because they have high rates of local recurrence, some subtypes can metastasize, and are poorly responsive to radiotherapy and chemotherapy. Case report: Female patient, 45 years old, presented abdominal pain and palpable abdominal mass in 2017. She underwent resection of well-differentiated liposarcoma of the retroperitoneum, without intercurrences. In 2020, she manifested abdominal pain and weight loss. Tomography showed multiple voluminous abdominal masses, with biopsy suggestive of dedifferentiated liposarcoma. The patient was submitted to neoadjuvant radiotherapy, followed by surgical resection of the masses and right ileocolectomy. In 2022, she presented symptoms suggestive of intestinal obstruction, and underwent laparotomy that revealed intense blockage of intestinal loops, duodenal fistula, retroperitoneal tumor, and fecal peritonitis. Retroperitoneal neoplasm resection, ileostomy and fistula closure were performed. Histopathology showed relapsed dedifferentiated liposarcoma. The patient evolved with operative and infectious complications, requiring intensive care and antibiotic therapy. After clinical improvement, the patient was discharged with enteral diet and continues under outpatient follow-up. Conclusion: Retroperitoneal liposarcoma may undergo multifocal dedifferentiation and recurrence, requiring several surgical approaches, increasing morbidity and the risk of complications. Wide margin surgery remains the main therapeutic modality.

Introducción: Los liposarcomas retroperitoneales son neoplasias mesenquimatosas raras, siendo los más comunes los liposarcomas bien diferenciados y desdiferenciados. El subtipo bien diferenciado puede sufrir desdiferenciación hacia tumores de mayor grado. Estas neoplasias son difíciles de tratar quirúrgicamente porque presentan altas tasas de recidiva local, algunos subtipos pueden hacer metástasis y responden mal a la radioterapia y la quimioterapia. Informe del caso: Mujer de 45 años, en 2017 presenta dolor abdominal y masa abdominal palpable. Fue sometida a la resección de un liposarcoma bien diferenciado del retroperitoneo, sin intercurrencias. En 2020, manifestó dolor abdominal y pérdida de peso. La tomografía mostró múltiples masas abdominales voluminosas, con biopsia sugestiva de liposarcoma desdiferenciado. Fue sometida a radioterapia neoadyuvante y luego a resección quirúrgica de las masas y a ileocolectomía derecha. En 2022, presentó síntomas de obstrucción intestinal y fue sometida a una laparotomía que reveló obstrucción de las asas intestinales, fístula duodenal, tumor retroperitoneal y peritonitis fecal. Se realizó la resección de la neoplasia retroperitoneal, la ileostomía y la fistulización. La histopatología mostró un liposarcoma desdiferenciado. La paciente evolucionó con complicaciones operatorias e infecciosas, requiriendo cuidados intensivos y terapia antibiótica. Tras la mejora clínica, la paciente fue dada de alta con dieta enteral y está en seguimiento. Conclusión: El liposarcoma retroperitoneal puede sufrir desdiferenciación multifocal y recurrencia, requiriendo varios a tratamientos quirúrgicos, aumentando la morbilidad y el riesgo de complicaciones. La cirugía con márgenes amplios sigue siendo la terapia principal.

Cancerous and non-neoplastic stem cells in the stomach similarly express CD44 and CD133.

CD44 and CD133 have been considered as cancer stem cell (CSC) markers. Stem cell markers are rarely described in healthy stomach tissues. However, the clinicopathological and prognostic value of CD44 and CD133 in gastric cancer remains controversial. This study investigated the expression of CD44 and CD133 in gastric cancer and non-neoplastic gastric mucosa. We used samples of primary gastric adenocarcinomas (n = 69), metastatic lymph nodes (n = 30), intestinal metaplasia (n = 17), and histologically normal gastric tissues of surgical margins (n = 54). The expression of CD44 and CD133 were studied in samples by immunohistochemistry. Fisher's exact test and a logistic regression model were used in this study. CD44 expression was observed in 12% of samples with intestinal metaplasia, 20% with lymph node metastases, 22% with normal mucosa, to 30% of samples with primary tumors. Most of these positive tumors showed immunostaining in less than 4% of cancerous cells, mainly in the diffuse type. CD133 expression was observed in 7% (intestinal metaplasia) to 46% (normal mucosa). In the positive cases of cancer (24%), in most of them, less than 3% of cells were marked. CD44 and CD133 expression in the histologically normal gastric mucosa was restricted to the deeper regions of the gastric crypts at the level where stem cells and progenitor cells are usually found. CD44 and CD133 expression occurs in few gastric cancer cells, mainly in diffuse carcinomas, and are expressed in histologically normal gastric mucosae. None of the markers are specific for cancer and are also present in intestinal metaplasia and the normal mucosa.

Extended pelvic resections for the treatment of locally advanced and recurrent anal canal and colorectal cancer: technical aspects and morbimortality predictors aftet 24 consecutive cases.

OBJECTIVE: to evaluate the profile of morbidity and mortality and its predictors related to extensive pelvic resections, including pelvic exenteration, to optimize the selection of patients and achieve better surgical results. METHODS: we performed 24 major resections for anorectal pelvic malignancy from 2008 to 2015 in the Instituto do Câncer do Ceará. The factors analyzed included age, weight loss, resected organs, total versus posterior exenteration, angiolymphatic and perineural invasion, lymph node metastasis and overall and disease-free survival. RESULTS: the median age was 57 years and the mean follow-up was ten months. Overall morbidity was 45.8%, with five (20.8%) serious complications. There were no deaths in the first 30 postoperative days. The median overall survival was 39.5 months, and disease-free survival, 30.7 months. Concomitant resection of the bladder was an isolated prognostic factor for higher risk of complications (87.5% vs. 26.7%, p = 0.009). Angiolymphatic invasion and lymph node metastasis did not reach significance with respect to disease-free survival. CONCLUSION: treatment of advanced anorectal tumors is challenging, often requiring combined resections, such as cystectomy and sacrectomy, and complex reconstructions. The magnitude of the operation still carries a high morbidity rate, but is a procedure considered safe and feasible, with a low mortality and adequate locoregional tumor control when performed in referral centers. OBJETIVOS: avaliar o perfil de morbimortalidade e seus fatores preditivos relacionados às ressecções pélvicas extensas, incluindo a exenteração pélvica, com o intuito de otimizar a seleção dos pacientes e obtenção de melhores resultados cirúrgicos. MÉTODOS: foram realizadas 24 grandes ressecções pélvicas por neoplasia maligna anorretal de 2008 a 2015 no Instituto do Câncer do Ceará. Os fatores analisados incluíram idade, perda de peso, órgão ressecados, exenteração total versus posterior, invasão angiolinfática e perineural, metástase linfonodal e sobrevida global e livre de doença. RESULTADOS: a mediana de idade foi 57 anos e o tempo médio de seguimento foi dez meses. A morbidade global foi 45,8%, com cinco (20,8%) complicações graves. Não houve óbito nos primeiros 30 dias de pós-operatório. A sobrevida global média foi 39,5 meses e a sobrevida livre de doença foi 30,7 meses. A ressecção concomitante da bexiga foi fator prognóstico isolado com maior risco para complicações (87,5% vs. 26,7%, p=0.009). Invasão angiolinfática e metástase linfonodal não alcançaram significância com relação à sobrevida livre de doença. CONCLUSÃO: o tratamento dos tumores anorretais avançados é desafiador, necessitando frequentemente de ressecções combinadas, como a cistectomia e sacrectomia, além de reconstruções complexas. A magnitude da cirurgia ainda carrega uma elevada taxa de morbidade, porém é um procedimento considerado seguro e factível, com uma baixa mortalidade e adequado controle locorregional tumoral quando realizado em centros de referência.

Extended pelvic resections for the treatment of locally advanced and recurrent anal canal and colorectal cancer: technical aspects and morbimortality predictors aftet 24 consecutive cases / Ressecções pélvicas alargadas no tratamento do câncer colorretal e de canal anal localmente avançado ou recidivado: análise dos aspectos técnicos e fatores de morbimortalidade em 24 casos consecutivos

ABSTRACT Objective: to evaluate the profile of morbidity and mortality and its predictors related to extensive pelvic resections, including pelvic exenteration, to optimize the selection of patients and achieve better surgical results. Methods: we performed 24 major resections for anorectal pelvic malignancy from 2008 to 2015 in the Instituto do Câncer do Ceará. The factors analyzed included age, weight loss, resected organs, total versus posterior exenteration, angiolymphatic and perineural invasion, lymph node metastasis and overall and disease-free survival. Results: the median age was 57 years and the mean follow-up was ten months. Overall morbidity was 45.8%, with five (20.8%) serious complications. There were no deaths in the first 30 postoperative days. The median overall survival was 39.5 months, and disease-free survival, 30.7 months. Concomitant resection of the bladder was an isolated prognostic factor for higher risk of complications (87.5% vs. 26.7%, p = 0.009). Angiolymphatic invasion and lymph node metastasis did not reach significance with respect to disease-free survival. Conclusion: treatment of advanced anorectal tumors is challenging, often requiring combined resections, such as cystectomy and sacrectomy, and complex reconstructions. The magnitude of the operation still carries a high morbidity rate, but is a procedure considered safe and feasible, with a low mortality and adequate locoregional tumor control when performed in referral centers.

RESUMO Objetivos: avaliar o perfil de morbimortalidade e seus fatores preditivos relacionados às ressecções pélvicas extensas, incluindo a exenteração pélvica, com o intuito de otimizar a seleção dos pacientes e obtenção de melhores resultados cirúrgicos. Métodos: foram realizadas 24 grandes ressecções pélvicas por neoplasia maligna anorretal de 2008 a 2015 no Instituto do Câncer do Ceará. Os fatores analisados incluíram idade, perda de peso, órgão ressecados, exenteração total versus posterior, invasão angiolinfática e perineural, metástase linfonodal e sobrevida global e livre de doença. Resultados: a mediana de idade foi 57 anos e o tempo médio de seguimento foi dez meses. A morbidade global foi 45,8%, com cinco (20,8%) complicações graves. Não houve óbito nos primeiros 30 dias de pós-operatório. A sobrevida global média foi 39,5 meses e a sobrevida livre de doença foi 30,7 meses. A ressecção concomitante da bexiga foi fator prognóstico isolado com maior risco para complicações (87,5% vs. 26,7%, p=0.009). Invasão angiolinfática e metástase linfonodal não alcançaram significância com relação à sobrevida livre de doença. Conclusão: o tratamento dos tumores anorretais avançados é desafiador, necessitando frequentemente de ressecções combinadas, como a cistectomia e sacrectomia, além de reconstruções complexas. A magnitude da cirurgia ainda carrega uma elevada taxa de morbidade, porém é um procedimento considerado seguro e factível, com uma baixa mortalidade e adequado controle locorregional tumoral quando realizado em centros de referência.

Chemotherapy-associated steatohepatitis induced by irinotecan: a novel animal model.

PURPOSE: Nonalcoholic steatohepatitis (NASH) has been associated with irinotecan (IRI)-based cancer chemotherapy regimens. The purpose of this study was to propose and test a consistent model of IRI-induced NASH, filling a gap in the medical literature. METHODS: Swiss male mice were distributed in groups (n = 8) and injected with saline (5 mL/kg, i.p.; control) or IRI (25, 50, 75 or 100 mg/kg, i.p.) thrice a week for 7 weeks. Blood samples were collected to measure the serum concentrations of proteins, alanine and aspartate aminotransferases (ALT and AST). Each week animals were euthanized, and the livers were submitted to myeloperoxidase (MPO) assay, lipid dosage, immunohistochemistry for inducible nitric oxide synthase (iNOS), TNF-α and interleukin-1ß (IL-1ß), and histopathological analysis. Survival rates were also determined. RESULTS: Mice treated with IRI had a significantly (p < 0.05) lower survival rate than controls and time- and dose-dependent body weight loss. ALT and AST plasma levels increased in relation to controls only in mice receiving IRI 50 mg/kg (p < 0.05). The histopathological features characteristic of NASH was observed, including steatosis, lobular neutrophil infiltration and ballooning hepatocytic degeneration. Additional findings included increased MPO, lipid accumulation, portal neutrophil infiltration, IL-1ß and iNOS expression and fibrosis in liver tissues and low serum protein levels compared to controls. CONCLUSION: This is the first report of a consistent model of IRI-induced NASH capable of mimicking clinical findings.

Solitary schwannoma of the cecum: case report and review of the literature.

A 78-year-old woman presented with an abdominal mass diagnosed by ultrasound and computed tomography. The patient underwent a laparotomy, during which a retroperitoneal tumor adherent to the cecum wall was identified. Microscopically, it showed spindle-cell proliferation in whorls, with low mitotic count (2 per 50 high-power fields) and was strongly positive for S-100 protein and vimentin. The final diagnosis was benign schwannoma of the cecum and no further treatment was required. Large intestine schwannomas are extremely rare tumors and only a few cases of schwannoma of the cecum have been reported to date.

Bile duct injury following cholecystectomy.

OBJECTIVE: To describe the epidemiological, clinical and surgical features of patients with iatrogenic bile duct injury (IBDI) attending the General Hospital of Fortaleza (HGF) during the period from 2005 to 2009. METHODS: We conducted a retrospective study of medical records of patients admitted to HGF with the diagnosis of IBDI, evaluating the following variables: gender, age, origin, conditions of cholecystectomy, type of surgery, symptoms, exams performed, surgical findings, classification of injury, treatment, complications, total duration of hospitalization and discharge conditions. RESULTS: There were 27 confirmed cases of IBDI. Two injuries occurred during laparoscopic cholecystectomy. Only one patient was diagnosed intraoperatively. The most frequent sign was jaundice after cholecystectomy. Hepato-duodenal Y-en-Roux anastomosis was the most often employed surgical technique (85.2%). Most patients were discharged from hospital in good clinical condition (88.8%), however, we found high morbidity rates for this disease, exemplified by the multiple hospitalizations and longer hospital stay (mean 31 days). CONCLUSION: Most injuries occurred during open cholecystectomy, jaundice was the most frequent sign upon admission. There was a high hospitalization length of stay, caused by postoperative complications, which could be explained by delayed diagnosis resulting in a large delay in treatment.

Lesão iatrogênica de via biliar pós-colecistectomia / Bile duct injury following cholecystectomy

OBJETIVO: Descrever os aspectos epidemiológicos, clínicos e cirúrgicos dos pacientes com lesão iatrogênica das vias biliares (LIVB) atendidos no Hospital Geral de Fortaleza (HGF) durante o período de 2005 a 2009. MÉTODOS: Realizou-se estudo retrospectivo dos prontuários dos pacientes internados no HGF diagnóstico de LIVB, obtendo-se as seguintes variáveis: sexo, idade, procedência, condições da colecistectomia, tipo de operação, sintomatologia, exames realizados, achados cirúrgicos, classificação da lesão, tratamento, complicações, tempo total de internamento e condições de alta. RESULTADOS: Foram confirmados 27 casos de LIVB. Duas lesões ocorreram durante a colecistectomia videolaparoscópica. Apenas um paciente foi diagnosticado no intra-operatório.. O sinal mais freqüente foi a icterícia pós-colecistectomia. A hepático-jejunostomia em "Y" de Roux foi a técnica cirúrgica mais empregada (85,2 por cento). A maioria dos pacientes recebeu alta hospitalar em boas condições clínicas (88,8 por cento); no entanto, constatou-se, a elevada morbidade desta patologia, exemplificada pelos múltiplos internamentos e longa permanência hospitalar (média de 31 dias). CONCLUSÃO: A maioria das lesões ocorreu durante a colecistectomia por laparotomia, a icterícia foi o sinal mais freqüente quando da internação Verificou-se uma elevada permanência hospitalar .causada pelas complicações pós-operatórias o que poderia ser explicado pelo diagnóstico tardio ocasionando um grande retardo no tratamento neste pacientes.

OBJECTIVE: To describe the epidemiological, clinical and surgical features of patients with iatrogenic bile duct injury (IBDI) attending the General Hospital of Fortaleza (HGF) during the period from 2005 to 2009. METHODS: We conducted a retrospective study of medical records of patients admitted to HGF with the diagnosis of IBDI, evaluating the following variables: gender, age, origin, conditions of cholecystectomy, type of surgery, symptoms, exams performed, surgical findings, classification of injury, treatment, complications, total duration of hospitalization and discharge conditions. RESULTS: There were 27 confirmed cases of IBDI. Two injuries occurred during laparoscopic cholecystectomy. Only one patient was diagnosed intraoperatively. The most frequent sign was jaundice after cholecystectomy. Hepato-duodenal Y-en-Roux anastomosis was the most often employed surgical technique (85.2 percent). Most patients were discharged from hospital in good clinical condition (88.8 percent), however, we found high morbidity rates for this disease, exemplified by the multiple hospitalizations and longer hospital stay (mean 31 days). CONCLUSION: Most injuries occurred during open cholecystectomy, jaundice was the most frequent sign upon admission. There was a high hospitalization length of stay, caused by postoperative complications, which could be explained by delayed diagnosis resulting in a large delay in treatment.

Prognostic score in gastric cancer: the importance of a conjoint analysis of clinical, pathologic, and therapeutic factors.

BACKGROUND: This study was designed to establish a prognostic score for gastric cancer that takes into account factors related to the tumor, the patient, and the treatment. METHODS: Two hundred thirty patients with gastric adenocarcinoma admitted t o the Department of Abdominal Surgery at Hospital do Câncer A. C. Camargo (São Paulo) and treated by gastrectomy from January 1992 until December 1996 were included in this retrospective cohort. The prognostic score was created according to the variables identified in the multivariate analysis and by using the regression coefficients generated by the Cox regression. RESULTS: The 5-year overall survival rate was 44.5%. The final multivariate model identified six variables with a significant and independent effect on survival: sex, weight loss, lymphocyte count, tumor-node-metastasis staging, lymphadenectomy, and lymph node ratio. Patients were divided into four groups according to their scores, as follows: group 1, 0 to 3.0; group 2, 3.5 to 5.5; group 3, 6.0 to 8.5; and group 4, 9.0 to 14.0. The 5-year survival rates were 91.5%, 49.3%, 20.3%, and .0% for the score groups 1, 2, 3, and 4, respectively (P<.001). The score was superior in the assessment of prognosis when compared with tumor-node-metastasis staging alone. CONCLUSIONS: It is possible to create a prognostic score that simultaneously includes factors related to the tumor, patient, and treatment, thus generating a more effective system in predicting the prognosis than the morphology-based staging systems.

Soft-tissue sarcomas of the chest wall: prognostic factors.

OBJECTIVE: To evaluate factors that are predictive of outcome for patients with chest wall soft-tissue sarcomas. PATIENTS AND METHODS: A retrospective review of 55 surgically treated patients, from March 1964 to October 1996. RESULTS: The median age of the patients was 47.5 years (age range, 15 to 76.3 years), and 56.4% were men. The most common presenting symptom was chest wall mass in 29 patients (52.7%). The median symptom duration was 12 months. Tumor size ranged from 1 to 26 cm (median size, 9.7 cm). The most common histologic type of tumor was fibrosarcoma (52.7%). Twenty-three sarcomas (41.8%) were high-grade, and 32 sarcomas (52.8%) were low-grade. Of the 55 patients, 27 (49.1%) had previously been treated elsewhere (surgical resection, 23 patients; radiation therapy and surgery, 3 patients; chemoradiation therapy, 1 patient). Previously treated patients presented either with residual disease (10 cases) or recurrence of disease (17 cases). All 55 patients underwent surgical resection, 15 patients (27.3%) were treated by neoadjuvant chemoradiation therapy, and 2 patients were treated by adjuvant radiotherapy. Wide surgical resection was performed in 45 patients (81.8%), and marginal resection was performed in 10 patients (18.2%). The median follow-up time was 51.9 months. Local recurrence of disease developed in 6 patients, and metastases developed in 10 patients. The overall survival rates at 5 and 10 years were 87.3% and 79.3%, respectively. Tumor size < 5 cm and low histologic grade were determinants of better survival at univariate analyses. Multivariate analyses disclosed only histologic grade as an independent predictor for the risk of death. Disease-free survival rates at 5 and 10 years were 75.3% and 64.2%, respectively. Tumor size < 5 cm, performance of wide surgical resection, and low histologic grade were determinants of a better disease-free survival rate. Independent prognostic factors for disease-free survival were histologic grade and type of surgical resection. CONCLUSION: The clinical behavior of chest wall soft-tissue sarcomas is similar to that of extremity sarcomas. Thoracic wall soft-tissue sarcomas are best controlled by wide surgical resection.