Association between surgical excision margins and outcomes in patients with dermatofibrosarcoma protuberans: A meta‐analysis

Abstract

Dermatofibrosarcoma protuberans (DFSP) is a tumor with low-grade malignancy and high recurrence rates. Wide local excision (WLE) is essential for DFSP, but its surgical excision margin is controversial. This study aimed to examine whether resection margin is associated with the prognosis of patients with DFSP by systematically reviewing related literature. Studies that evaluated the relationship between excision margins and outcomes after WLE were retrieved from the Cochrane Library, PubMed, Embase, and Web of Science databases. Relative risk (RR) estimates and 95% confidence intervals (CIs) were measured via a random-effect model to evaluate the subsequent outcomes: recurrence rate, mortality, and positive surgical margin rate. Sensitivity and subgroup analyses were simultaneously carried out. The metaanalysis of eight observational literatures demonstrated a significant positive correlation of ≥3 cm margin with the recurrence rate (RR = 0.17, 95% CI 0.09-0.31) and the positive surgical margin rate (RR = 0.09, 95% CI 0.02-0.46). The same result was observed in the recurrence rate in all subgroups. The stability of the above outcomes was authenticated via sensitivity analyses. Our meta-analysis illustrated that excision with <3 cm surgical margin exhibited an increased risk of poor DFSP prognosis (high recurrence rate and increasing positive margin rate).

Dermatofibrosarcoma protuberans surgery: Experiences of four African surgical oncology units and literature review

“…In addition, the tumors in our practice settings are large as in most cases reported in the African literature 6,17,30 . Also, the dermatofibrosarcoma of Darier and Ferrand is known to have macroscopically invisible filiform pseudopodia that may extend several centimeters beyond the palpable limit of the tumor 17,24 . All these reasons explain why in our series, the resections were wide and deep.…”

“…6,17,30 Also, the dermatofibrosarcoma of Darier and Ferrand is known to have macroscopically invisible filiform pseudopodia that may extend several centimeters beyond the palpable limit of the tumor. 17,24 All these reasons explain why in our series, the resections were wide and deep. These large resections are corollary to large wounds that cannot be covered by direct skin suture.…”

“…17,18,22 These are: resection-suture, resection-healing by secondary intention, resection-flap covering and resection-skin grafting preceded or not by a first phase of healing by secondary intention. 18,[23][24][25] Regardless of the coverage technique used, the surgery has a single goal, which is to obtain healthy surgical margins. Two principles are used to achieve this goal.…”

Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer

“…A previous meta-analysis revealed that WLE with a 4 cm surgical margin provides 95% tumor clearance [ 124 ]. Another meta-analysis of eight observational studies revealed a significant positive correlation between a margin of more than 3 cm and the LRR and positive surgical margin rate [ 125 ]. However, the larger the surgical margin is, the more significant the cosmetic and functional problems that develop after WLE may be [ 126 ].…”

Dermatofibrosarcoma protuberans：clinical and pathological analysis of Asian samples from one center experience.

“…Jelena Jeremic et al(16) reported a 55 years old female diagnosed as DFSP with nodular lesion 18x10cm. It was indicated by previous reports that excision margin less than 3cm increased recurrence(17).Charlotte Van Lee et al(18) indicated that the experience of surgeon, subcutaneous tentacle-like invasion and the symmetrical manner disease center contribute to high recurrence of DFSP. Xiong et al(19) reported the diameter of DFSP over 3cm maybe the risk factor of recurrence even though the statistical result did not show statistical signi cance.…”