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Objectives and questions: When soft-tissue sarcomas occur near neurovascular structures, preoperative images cannot always accurately reveal relationship between the tumor and these important structures. Consequently, in some patients, neurovascular structures are sacrificed unnecessarily. On the contrary some patients, neurovascular structures are preserved with an inappropriate margin, followed by local recurrence. Our objective was to evaluate the surgical method of “in situ preparation”(ISP), which enables the preparation of neurovascular bundles and intraoperative evaluation of the surgical margin without contamination by tumor cells. With this method, additional procedures, including pasteurization, alcohol soaking, and distilled water soaking of the preserved neurovascular bundle can also be performed to preserve the continuity of vessels. Is ISP followed by external beam radiotherapy a useful method with which can ensure a safe surgical margin and good functional results in special situations when soft-tissue sarcomas occur near major neurovascular structures.

Material and methods: Between March 2005 and October 2020, five patients with soft-tissue sarcoma were operated on using ISP. Four of them the posterior thigh was involved and the tumor and sciatic nerve were lifted en bloc from the surgical bed and separated from the field by the use of a vinyl sheet. While one patient the distal arm was involved and the tumor, the median nerve and brachial artery were lifted en bloc from the surgical bed and separated from the field by the use of a vinyl sheet. The consistency and the continuity of the neurovascular structures was preserved. The tumour block could be freely turned around and the neurovascular structure was separated from the block through the nearest approach.

The margin between the tumor and neurovascular structure was evaluated, and an additional procedure, such as alcohol soaking or distilled water soaking, was performed. Postoperative external beam radiotherapy was used in all patients.

Results: After a mean follow up of ten years, there is no local recurrence after our ISP. All patients are continuously disease free and all patients retain complete functional activities of the involved neurovascular structures. Complications after ISP were transient nerve palsy in two patients, one of median nerve and one sciatic nerve but also postoperative radiotherapy could play a role in this complication.

Discussion and conclusion: ISP followed by external beam radiotherapy is a useful method with which can ensure a safe surgical margin and good functional results in special situations when soft-tissue sarcomas occur near major neurovascular structures.