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Limb-sparing surgery with pre- or postoperative irradiation has evolved as the standard of care for local tumor control of soft tissue sarcoma while ablative procedures are applied in selected cases only. Adequate excision of sarcoma is prerequisite to guarantee local tumor control. While excision with wide margins has been educated in the past, tumor excision with closer margins has shown to provide similar local tumor control. Beside this oncological aspect, type of surgery and reconstruction impact the functional outcome after sarcoma excision in the extremities, which adds to quality of life for the patients. Satisfactory results have been shown by different scoring systems; however, more recent studies focus on high level activities like sports to define the efficacy of different procedures. This review focuses on recent developments within these two topics.