An optimal treatment of soft tissue sarcomas is influenced by multiple factors. An improvement of the still unfavourable prognosis for some patients with soft tissue sarcomas with a high local recurrence rate, oftly based on an inadequate surgical primary therapy, can be achieved only if guidelines described in this paper gain increasing influence in practice. The treatment concept for malignant soft tissue sarcomas must be worked out a priori interdisciplinary after knowledge of all relevant dates and findings. Surgery is here only one, but at the right time an essential component of therapy. The R0 resection is an important requirement for a freedom of local recurrence, but the influence of a local recurrence on overall survival remains controversial. Therefore amputations should be taken into consideration only after exhaustion of all available procedures.