Smaller Surgical Margins May Help Protect Healthy Tissue in Young Sarcoma Patients

Non-rhabdomyosarcoma soft tissue sarcomas arise in tissues that normally develop into muscles, nerves, and tendons. Removing these tumors in children and young adults requires balancing cancer clearance against preservation of surrounding healthy tissue. Wider surgical margins may reduce concern about residual cancer but can also damage nerves, blood vessels, tendons, and joints. Offering new evidence to inform this balance, new findings suggest that narrower cancer-free margins may preserve healthy tissue while maintaining local control in selected pediatric and young adult patients.

Researchers led by UC Davis (Davis, CA, USA) evaluated surgical margin width in non-metastatic non-rhabdomyosarcoma soft tissue sarcoma through the Children’s Oncology Group ARST0332 trial. The standard treatment is complete resection, known as R0, in which no cancer cells remain at the microscopic edges of the removed tissue. Traditional protocols have recommended a 1- to 2-centimeter margin when feasible, but this can be difficult in smaller bodies without compromising important anatomic structures.

The prospective trial assessed 266 patients younger than 30 years, with a median age of 13.7 years. All patients had complete tumor resection with cancer-free margins. Among them, 178 received surgery alone, while 88 also received chemotherapy and radiation either before or after surgery. Researchers reviewed diagnostic imaging, tumor biopsies, resection specimens and operative records, with a median follow-up of 6.2 years.

Exact margin widths were available for 132 patients. In this group, the estimated five-year risk of local recurrence was 4.9% with a 1-millimeter margin, 2.0% with a 2- to 5-millimeter margin and 0% with a margin of 6 millimeters or more. The study also reported a 5.6% local recurrence risk among patients with smaller tumors treated with surgery alone, and a 3.7% risk among patients with large tumors who received chemotherapy. The findings were published in JAMA Surgery on October 28, 2026.

The results support individualized surgical planning by teams experienced in pediatric sarcoma care. Treatment decisions must account for tumor type, tumor behavior, nearby nerves and blood vessels, and the need for chemotherapy or radiation. Stanford University was also involved in the study.

“For a child, a few millimeters can make a lifelong difference when a tumor is next to an important nerve or blood vessel. These findings give us more evidence to help remove the cancer while protecting as much healthy tissue as possible,” said R. Lor Randall, UC Davis Health orthopedic surgeon and chair of the Department of Orthopaedic Surgery.

“For the first time, we have evidence from a large prospective trial to help answer how closely we can safely get to these tumors,” Randall explained. “So, it is very exciting to find that getting close to the tumor — within a millimeter — can potentially save a blood vessel or healthy tissue and meet the standard of care, something that had never been shown before,” said Randall.

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