Does Delayed Reexcision Affect Outcome After Unplanned Excision for Soft Tissue Sarcoma?

Han, Ilkyu; Kang, Hyun Guy; Kang, Seung Chul; Choi, Jay Rim; Kim, Han‐Soo

doi:10.1007/s11999-010-1642-8

Cited by 33 publications

(23 citation statements)

References 15 publications

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“…Likewise, this study was not designed to address inappropriate surgical intervention before diagnosis. This impact has been studied previously with bone sarcoma [2] and with soft tissue sarcoma [14,25]. Reasons for increased surgical morbidity are multifocal and complex.…”

Section: Discussionmentioning

confidence: 96%

Length of Symptoms Before Referral: Prognostic Variable for High-grade Soft Tissue Sarcoma?

Rougraff¹,

Lawrence²,

Davis³

2012

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 96%

Length of Symptoms Before Referral: Prognostic Variable for High-grade Soft Tissue Sarcoma?

Rougraff¹,

Lawrence²,

Davis³

2012

Clinical Orthopaedics &Amp; Related Research

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“…The study periods spanned the 1990s and/or 2000s, and dated back to the 1980s for 9 studies (Hsieh et al, 2003;Campbell et al, 2004;Hsu et al, 2004;Dickinson et al, 2006;Wu et al, 2006;Kim et al, 2007;2008c;Huang et al, 2010;Han et al, 2011) and the 1970s for 1 study (Wang et al, 2009) (Table 1). The number of patients [minimum, 12 (Jun et al, 2010); maximum, 324 (Dickinson et al, 2006) was fewer than 50 in 17 of the 32 studies.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…Only 13 studies specified whether STS was primary or recurrent [8 primary (Dickinson et al, 2006;Hui et al, 2006;Wu et al, 2006;An et al, 2007;Kim et al, 2008a;Ng and Tan, 2009;Wang et al, 2009;Liu et al, 2010); 5 primary or recurrent (Hsieh et al, 2003;Kiatisevi et al, 2006;Moncrieff et al, 2008;Miki et al, 2010;Cho et al, 2011)]. Patients had local disease in 15 studies (Choong et al, 2003;Campbell et al, 2004;Hsu et al, 2004;Dickinson et al, 2006;Hui et al, 2006;An et al, 2007;Kim et al, 2007;2008c;Pervaiz et al, 2008;Rudiger et al, 2009;Wang et al, 2009;Liu et al, 2010;Cho et al, 2011;Han et al, 2011), and local or metastatic disease in 7 studies (Wu et al, 2006;Chan et al, 2008;Moncrieff et al, 2008;Koh et al, 2009;Jun et al, 2010;Park et al, 2010;Lee et al, 2011). The remaining 10 studies did not specify whether disease was local or metastatic.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…Survival rates (OS or DSS; 7 studies) varied from 59% (5-year OS) for extremity and trunk pleomorphic sarcoma (26% FNCLCC grade III) (Kim et al, 2007) to 88% (actuarial 5-year DSS) for extremity and trunk sarcoma (42% FNCLCC grade III) (Han et al, 2011). The rate of local recurrence and/or distant metastases (5 studies) varied from 24% for extremity and trunk sarcoma (42% FNCLCC grade III) (Han et al, 2011) to 48% for extremity and trunk synovial sarcoma (36% high grade) (Campbell et al, 2004). In a study of extremity and trunk pleomorphic sarcoma (26% FNCLCC grade III) (Kim et al, 2007), the rates of local recurrence and distant metastases were 47% and 45%, respectively; however, whether patients had both local recurrence and distant metastases was not specified.…”

Section: Local Diseasementioning

confidence: 99%

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Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review

Ngan¹,

Wang²,

Porter³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 14 (11), [6821][6822][6823][6824][6825][6826][6827][6828][6829][6830][6831][6832] Introduction Soft-tissue sarcomas (STS) are a heterogeneous group of rare tumours. More than 50 STS histotypes have been identified, with most having unique clinical, prognostic, and therapeutic features. Although less than 1% of all adult malignant tumours are STS (Fletcher et al., 2002a), their treatment and management is complex because many tumour-related (eg, histotype, site, size, depth, grade, primary vs recurrent) (Singer et al., 1994;2000;Pisters et al., 1996) and treatment-related (eg, surgical margins, use of adjuvant therapy) (Singer et al., 2000) factors influence patient outcomes. Because these factors are inherently variable and because STS is rare, the management of patients with STS is best undertaken by an experienced multidisciplinary team in specialist centres to minimise recurrence, maximise survival, and preserve functionality and quality of life (Ray-Coquard et al., 2004;Luis et al., 2010; National Comprehensive Cancer Network, 2012).The standard primary treatment for STS is surgical AbstractBackground: Soft-tissue sarcomas require tailored and multidisciplinary treatment and management. However, little is known about how sarcomas are treated and managed throughout the Asia-Pacific region. Materials and Methods: MEDLINE was systematically searched using prespecified criteria. Publications (previous 10 years) that reported tumour characteristics, treatment patterns, survival outcomes, and/or safety outcomes of patients with soft-tissue sarcoma were selected. Exclusion criteria were studies of patients <18 years of age; ≤10 patients; countries other than Australia, Hong Kong, Indonesia, Korea, Malaysia, New Zealand, Philippines, Singapore, Taiwan, or Thailand; >20% benign tumours; sarcomas located in bones or joints; gastrointestinal stromal tumour; Kaposi's sarcoma; or not reporting relevant outcomes. Results: Of the 1,822 publications retrieved, 35 (32 studies) were included. Nearly all patients (98%, 1,992/2,024; 31 studies) were treated with surgery, and more studies used adjuvant radiotherapy than chemotherapy (24 vs 17 studies). Survival outcomes and recurrence rates varied among the studies because of the different histotypes, sites, and disease stages assessed. Only 5 studies reported safety findings. Conclusions: These findings highlight the lack of specific data available about soft-tissue sarcomas in the Asia-Pacific region. Better efforts to understand how the sarcoma is managed and treated will help improve patient outcomes in the region.

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“…Han et al 19 reported that any influence of delayed remargin surgery is likely to be of minor clinical importance. 20 …”

Section: Reexcision Timingmentioning

confidence: 99%

Unplanned resection of soft tissue sarcoma

Chen

2015

Formosan Journal of Surgery

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Unplanned surgery of a soft tissue sarcoma is defined as the gross removal of a tumor without appropriate preoperative imaging, biopsy, or attention to the wide surgical margin. Referrals after unplanned surgery account for between 14.7% and 53% of new patients in sarcoma centers. Treatment includes multiple modalities. It has been reported that 35e74% of residual sarcomas are found in reexcised specimens. Therefore, additional reexcision is typically warranted to remove the residual tumor and obtain an adequately safe margin. Adjuvant radiotherapy is generally used if the sarcoma is large, high grade, and deeply located. Adjuvant chemotherapy remains controversial because of its marginal benefits. A recent study indicated that adjuvant chemotherapy, an ifosfamide/epidoxorubicin protocol, showed 19% improvement in overall survival at 4 years. Therefore, adjuvant chemotherapy should be reserved for patients with a large, high-grade, localized lesion, and stage-IV disease. Unplanned surgery of high-grade sarcomas has resulted in increased rates of local recurrence but not disease-specific survival. Adequate additional reexcision may improve local control and survival. To avoid unplanned surgery of soft tissue sarcomas, guidelines have been recommended for clinicians to increase their awareness of the clinical features that suggest malignancy in any soft tissue lump.

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Does Delayed Reexcision Affect Outcome After Unplanned Excision for Soft Tissue Sarcoma?

Abstract: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 33 publications

References 15 publications

Length of Symptoms Before Referral: Prognostic Variable for High-grade Soft Tissue Sarcoma?

Length of Symptoms Before Referral: Prognostic Variable for High-grade Soft Tissue Sarcoma?

Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review

Unplanned resection of soft tissue sarcoma

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