Impact of Unplanned Resection and Re-excision of a Soft Tissue Sarcoma on Prognosis

Muñoz, Paula; Bajawi, Mariam; Barranquero, Alberto G; Mateos, Antonio Mena; Moreno, Sara Corral; Dehesa, A. Sanjuanbenito; Montero, José María; Martínez, Eduardo Lobo

doi:10.1016/j.cireng.2020.04.009

Cited by 4 publications

(1 citation statement)

References 21 publications

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“…Therefore, in our study, we used the PSM approach for possible confounding factors, which makes the analyses more precise. Compared to other relevant studies (9,20,21,23), the patients included in our study were more likely to have smaller tumor size, and fibrosarcoma and undifferentiated sarcoma were the most common types of histology in our study. Based on our analysis, we found that UPE followed by R0 resection was associated with a better LRFS and 3-year LRFS rates than PE.…”

Section: Discussionmentioning

confidence: 67%

The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis

Liang

Guo

et al. 2021

Front. Oncol.

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BackgroundUnplanned excision (UPE) of soft tissue sarcoma (STS) is often chosen in the early phase by general physicians without any radiological evaluation.PurposeThe present study aimed to evaluate the impact of UPE on the clinical outcomes of patients with STS of the trunk and extremity.Materials and MethodsPatients with STS of the trunk and extremity who underwent R0 resection between 1998 and 2016 were included and divided into the UPE and planned excision (PE) groups. Propensity score matching (PSM) was used to control the selection bias. The endpoints were disease-specific survival (DSS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS).ResultsIn total, 458 patients (277 males, 181 females; median age: 43 years) were included: 329 (71.8%) in the PE group and 129 (28.2%) in the UPE group. The follow-up time ranged from 7.1 to 313.78 months, with a median of 112.18 months. UPE patients were more likely to have a smaller or superficial lesion and were more frequently administered adjuvant therapy. After PSM, compared with the PE group, the UPE group had a longer LRFS (P=0.015), but there was no difference between the two groups regarding DSS and MFS. Residual disease was observed in 77.5% of the re-resected specimens in the UPE group and was a risk factor for DSS (P = 0.046) and MFS (P = 0.029) but was not associated with local recurrence (LR) (P=0.475) or LRFS (P=0.334). Moreover, we found no difference in DSS, LRFS or MFS according to the interval from UPE to definitive resection.ConclusionSTS treated with UPE had distinct characteristics. Patients who undergo UPE followed by an additional wide R0 resection have similar oncological survival compared to patients who undergo an initial PE, although the high incidence of residual tumor in the UPE group leads to an unfavorable clinical course.

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Section: Discussionmentioning

confidence: 67%

The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis

Liang

Guo

et al. 2021

Front. Oncol.

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External and internal hemipelvectomy: A retrospective analysis of 68 cases

et al. 2022

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External and internal hemipelvectomy are rare surgical treatment methods applied in primary malignant tumors of the pelvis, pelvic metastases, infections or severe trauma. [1,2] Bone and soft tissue tumors of the pelvis are rare and difficult to treat due to the complex anatomical structure of the region. At the time of hospital admission, the tumor size is usually large and surgical treatment is difficult due to its close relationship with neurovascular, intestinal and urogenital structures. [2] The diagnosis process starts with clinical suspicion and physical examination and, then, appropriate imaging techniques are used. After the radiological work-up, a biopsy procedure is performed to identify the histopathological diagnosis. [3] The indication for internal or external hemipelvectomy is determined depending on the tumor size, stage, location, proximity to neurovascular structures and abdominal organs. [1,2,4] Internal Objectives: This study aims to investigate the factors that may be associated with surgical site infection and mortality in pelvic resection surgeries.Patients and methods: A total of 68 patients (40 males, 28 females; mean age: 43±16.2 years; range, 11 to 70 years) who underwent internal or external hemipelvectomy between January 2010 and January 2020 were retrospectively analyzed. We reviewed data concerning histopathological diagnosis, surgical technique, pelvic resection type, tumor size, postoperative infection, duration of follow-up, and mortality. Results:The mean follow-up was 45.5±42.2 months. Among 68 patients, 29 (42.6%) cases underwent external hemipelvectomy and 39 (57.4%) cases underwent internal hemipelvectomy. Reconstruction was performed in 14 (20.6%) patients who underwent internal hemipelvectomy. Of all patients, 61 had primary malignant pelvic tumors and two had metastatic pelvic tumors. Of the other five patients, two had a giant cell tumor, two had a pelvic hydatid cyst, and one had an aneurysmal bone cyst. The three most common pelvic tumors were chondrosarcoma (n=25, 36.7%), osteosarcoma (n=13, 19.1%), and Ewing sarcoma (n=8, 11.8%). Surgical site infections were observed in 34 (50.0%) patients. Of 34 patients, 15 (22.1%) had superficial infections and 19 (27.9%) had deep surgical infections. The superficial and deep infection rates were higher in the external hemipelvectomy group compared to internal hemipelvectomy (p=0.02). Patients with postoperative infection had a mean survival period of 36.0 months compared to 79.8 months in patients without infection (p=0.037). The patients treated with internal hemipelvectomy had a mean survival of 97.0 months compared to 25.7 months in patients treated with external hemipelvectomy (p<0.0001). The effect of Enneking stages of malignant pelvic tumors on survival was investigated using the Kaplan-Meier analysis. Cumulative survival decreased, as the stage progressed (p<0.0001). Conclusion:The type of surgical technique affects the possibility of postoperative infection. Postoperative infection, surgical method, and stage of the tum...

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Positive Margins Following Excision of Primary Bone & Soft Tissue Tumours in a Tertiary Centre and the Impact on Patient Outcomes

Matheron¹,

Ardakani²,

Nasir³

et al. 2022

Cureus

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BackgroundPrimary bone and soft tissue sarcoma treatment includes surgical resection, with or without peri-operative chemoradiotherapy. The aim of surgery is to achieve complete excision, to prevent localised recurrence and achieve cure. For various reasons, excision with adequate margins is not always possible. Our aim is to assess the occurrence of unexpected positive margins following primary excision within a tertiary centre and the impact on patient outcomes. MethodsA retrospective analysis of 567 patients discussed at the Royal National Orthopaedic Hospital Multidisciplinary team (MDT) meeting with positive margins between 1999-2020 was performed. Exclusion criteria included: excisions performed externally and lesions treated with curettage. Information gathering from electronic records highlighted 23 cases with unexpected positive margins following primary excision. ResultsAll patients pre-operatively expected to achieve complete primary resection. The median age was 60 years (8-92), 10M:13F. Tumour location included lower limb (12), upper limb (six), pelvis (two) and trunk (three); eight bone tumours and 15 soft tissue. The overall recurrence rate was 30.4% (7/23). In those recommended for re-excision (n=16), the recurrence rate was 31.25% (5/16). Of the patients not initially recommended for re-excision (n=7), four proceeded to surveillance alone with 50% recurrence (2/4), both with metastatic disease not surviving to follow-up. A further three patients underwent post-operative radiotherapy alone with no recurrences at follow-up, one patient not surviving for further treatment due to stroke. The mean follow-up for patients was 3.1 years. ConclusionWhen positive margins do occur unexpectedly, the impact due to the need for further treatment and ultimately increased risk of recurrence can be significant. Results can be compared to those for unplanned excisions. Therefore, surgeons should be aware of the different circumstances in which positive margins occur to help guide treatment planning and managing patient expectations.

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Impact of Unplanned Resection and Re-excision of a Soft Tissue Sarcoma on Prognosis

Cited by 4 publications

References 21 publications

The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis

The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis

External and internal hemipelvectomy: A retrospective analysis of 68 cases

Positive Margins Following Excision of Primary Bone & Soft Tissue Tumours in a Tertiary Centre and the Impact on Patient Outcomes

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