Upper- versus lower-extremity synovial sarcoma: distinct surgical pathways and postoperative morbidity in a 24-year cohort.

Authors

Pia Weskamp, Marius Drysch, Alexander Fiedler, Sonja Verena Schmidt, Felix Reinkemeier, Yonca Steubing, Marcus Lehnhardt, Mehran Dadras, Flemming Puscz, Christoph Wallner

Published in

Journal of cancer research and clinical oncology. Volume 152. Issue 9. Sep 18, 2026. Epub Sep 18, 2026.

Abstract

Synovial sarcoma is a rare, late-relapsing soft-tissue sarcoma of the extremities. Whether anatomical location shapes the surgical treatment pathway, rather than prognosis alone, is unclear. We compared upper-extremity (UE) and lower-extremity (LE) tumors with respect to margin status, re-excision, reconstruction, morbidity and long-term oncological events.
Retrospective single-center cohort of 59 consecutive patients with histologically confirmed extremity synovial sarcoma treated between 2000 and 2023. Co-primary endpoints were a microscopically positive margin (R1) at the index resection and any postoperative complication within 8 weeks (Clavien-Dindo). Metastasis-free survival (MFS) and overall survival were exploratory. Fisher exact, Mann-Whitney U, Kaplan-Meier and log-rank methods were used; odds ratios (OR) are UE relative to LE.
Twenty-three tumors were UE and 36 LE. R1 at the index resection was more frequent in UE tumors (14/23 [61%] vs. 5/36 [14%]; OR 9.64, 95% CI 2.73-34.1; P < 0.001), as was neoadjuvant therapy (39% vs. 8%; P = 0.007). Definitive R0 was achieved in all patients. Any postoperative complication (13% vs. 53%; OR 0.13, 95% CI 0.03-0.53; P = 0.002) and major complications (9% vs. 39%; P = 0.015) were more frequent after LE surgery. Seven of nine distant metastases occurred in LE tumors, several beyond six years; ten-year MFS was 90% versus 56% (log-rank P = 0.095).
Upper- and lower-extremity synovial sarcomas followed distinct surgical pathways and carried distinct morbidity profiles, whereas definitive R0 resection was attained in both. The time-to-event findings are exploratory and require multicenter validation.

PMID:
42762267
Bibliographic data and abstract were imported from PubMed on 20 Sep 2026.

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