# Multidisciplinary Treatment of Inguinoscrotal Sarcomas: Analysis of 39 Cases Treated by Surgical Approach

## TL;DR

This study analyzes 39 cases of rare inguinoscrotal sarcomas, emphasizing the importance of multidisciplinary treatment and the role of histological grade in predicting survival.

## Contribution

The paper provides insights into the management and prognostic factors of inguinoscrotal sarcomas based on a referral hospital's experience.

## Key findings

- High-grade tumors were associated with worse overall and disease-free survival.
- Liposarcoma was the most frequent histology observed in the 39 patients.
- Seven patients required microvascularized free flap reconstruction for radical resection.

## Abstract

Inguinoscrotal sarcomas are extremely rare tumors. The treatment of choice is complete resection during the first surgery. A multidisciplinary approach is needed as a radical resection may necessitate vascular or free flap reconstruction for limb preservation. The aim of this study was to improve knowledge of this disease by presenting our experience regarding its management, oncologic results, and prognostic factors. A retrospective analysis was conducted on 39 patients treated surgically at our sarcoma referral hospital.. Histological grade has been confirmed as one of the main prognostic factors, being associated with worse overall and disease-free survival.

Background: Inguinoscrotal sarcomas are a rare sarcoma subtype. The treatment of choice is radical inguinal orchiectomy with wide local resection of the surrounding soft tissues. However, consensus regarding prognostic factors is lacking. We present our experience at a referral sarcoma center concerning the management, oncologic results, and prognostic factors pertaining to this disease. Methods: We conducted a retrospective analysis of patients who underwent surgery for inguinoscrotal sarcomas between 2005 and 2023 at a sarcoma referral hospital. Results: The study included 39 patients. The most frequent histology was liposarcoma. Seven patients required surgical reconstruction with a microvascularized free flap. Four patients presented major postoperative complications. Mean follow-up was 46 months. Overall survival rates were 97.4%, 81.7%, and 64.8% at one, three, and five years. High-grade tumors were correlated with worse overall and disease-free survival. Conclusions: The chance finding of a sarcoma in the inguinal region poses a diagnostic and therapeutic dilemma when considering options for treatment with curative intent. Vascular and muscle resection followed by vascular and/or free flap reconstruction may be necessary to achieve complete surgical resections; therefore, a multidisciplinary approach is needed. A preoperative biopsy should be performed to establish the histological grade, which may be the main prognostic factor.