Improved survival for extremity soft tissue sarcoma treated in high‐volume facilities

Abarca, Tyler L; Gao, Yubo; Monga, Varun; Tanas, Munir R.; Milhem, Mohammed; Miller, Benjamin J.

doi:10.1002/jso.25052

Cited by 57 publications

(39 citation statements)

References 38 publications

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“…A nationwide study by Blay et al 8 investigated 35 784 patients with sarcoma and found that surgery at a reference center was significantly associated with overall survival, findings that are supported by several other studies. When looking specifically at STS‐E, several studies utilizing the NCDB have demonstrated that facility surgical volume is associated with overall survival in the management of STS‐E 13,29 . Our study found that a higher hospital volume was indeed associated with improved survival in a multivariate analysis.…”

Section: Discussionsupporting

confidence: 53%

“…Patients were further stratified by hospital procedural volume. An established threshold for hospital volume to be considered a “high‐volume” has not been established, though numerous studies report a similar range 13,29 . Therefore, procedural volume was determined by quartiles of both hospitals and patients to ascertain whether trends in differences across strata were consistent.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, procedural volume was determined by quartiles of both hospitals and patients to ascertain whether trends in differences across strata were consistent. Volume strata were defined as < 10 or ≥ 10 cases/year based on previously published literature 13,29 . Then, to characterize the relationship between hospital volume and TOs across different years of the study period, yearly risk‐adjusted TO rates were estimated across hospital volume categories.…”

Section: Methodsmentioning

confidence: 99%

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Defining a textbook surgical outcome for patients undergoing surgical resection of intermediate and high‐grade soft tissue sarcomas of the extremities

Lazarides

Cerullo

Moris

et al. 2020

Journal of Surgical Oncology

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Background Quality measures for the surgical management soft tissue sarcoma of the extremity are limited. The purpose of this study was to define a textbook surgical outcome (TO) for soft tissue sarcoma of the extremities (STS‐E) and to examine its associations with hospital volume and overall survival. Methods All patients in the National Cancer Database undergoing resection of primary STS‐E between 2004 and 2015 were identified. The primary outcome was a TO, defined as: hospital length of stay (LOS) <75th percentile, survival >90 days from the date of surgery, no readmission within 30 days of discharge, and negative surgical margins (R0 resection). Results Overall, 7658 patients met criteria for inclusion; a TO was achieved in 4291 (56%) patients. Of patients who did not achieve TOs, 51.9% (n = 1748) had an extended LOS, and 47.3% (n = 1591) did not have negative margins. Older age, more medical comorbidities, and non‐white or black race were independently associated with not receiving a TO (P = .034). With respect to tumor and treatment characteristics, larger tumor size, lower extremity location and higher grade were independently associated with not receiving a TO (P < .001). Hospital volume was not associated with a TO. TOs conferred a significant survival benefit (hazrds ratio = 0.71 [0.65‐0.78], P < .001). A TO was associated with a 27.5% longer survival time (P < .001). Conclusions This study defined a TO in intermediate and high‐grade STS‐E and demonstrated that this outcome measure is associated with overall survival. Facility volume was not associated with a TO.

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Section: Discussionsupporting

confidence: 53%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Defining a textbook surgical outcome for patients undergoing surgical resection of intermediate and high‐grade soft tissue sarcomas of the extremities

Lazarides

Cerullo

Moris

et al. 2020

Journal of Surgical Oncology

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“…With regard to the need for surgical expertise, there are recent data describing a higher rate of microscopic negative margins and a trend toward improved outcomes in patients treated at high‐volume centers with specialized sarcoma surgeons 7 . Furthermore, a recent study found that patients with extremity STS who underwent surgery at high‐volume hospitals had survival rates of 87% at 2 years, 73% at 5 years, and 58% at 10 years, whereas patients treated at low‐volume hospitals had survival rates of 84%, 65%, and 53%, respectively, for the same periods 11 . These findings support the axiom that surgical oncologists and orthopedic surgeons with experience in treating patients with STS are crucial and are more knowledgeable regarding the latest literature on oncologic surgical practices.…”

Section: Introductionmentioning

confidence: 99%

Soft‐tissue sarcoma in adults: An update on the current state of histiotype‐specific management in an era of personalized medicine

Gamboa

Gronchi

Cardona

2020

CA A Cancer J Clinicians

378

340

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Soft-tissue sarcomas (STS) are rare tumors that account for 1% of all adult malignancies, with over 100 different histologic subtypes occurring predominately in the trunk, extremity, and retroperitoneum. This low incidence is further complicated by their variable presentation, behavior, and long-term outcomes, which emphasize the importance of centralized care in specialized centers with a multidisciplinary team approach. In the last decade, there has been an effort to improve the quality of care for patients with STS based on anatomic site and histology, and multiple ongoing clinical trials are focusing on tailoring therapy to histologic subtype. This report summarizes the latest evidence guiding the histiotype-specific management of extremity/truncal and retroperitoneal STS with regard to surgery, radiation, and chemotherapy.

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“… 16 In the setting of extremity sarcoma, a recent study using the National Cancer Database has shown that the ratio of amputation is only 8% and that of limb salvage is 92%. 17 In our case series, 4 patients suffered from sarcoma on a lower extremity, and limb salvage was achieved using the PAP flap.…”

Section: Discussionmentioning

confidence: 90%

Use of the Profunda Femoris Artery Perforator Flap for Reconstruction after Sarcoma Resection

Karakawa

Yoshimatsu

Maeda

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Soft tissue sarcomas are rare neoplasms that can occur on any part of the body. The operative position for the resection is determined depending on the site of the soft tissue sarcomas; intraoperative repositioning may be needed for reconstruction. We present the profunda femoris artery perforator (PAP) flap harvest technique (wherein the flap can be used in any position), and suggest that the PAP flap transfer can eliminate the need for intraoperative repositioning. Methods: From December 2018 to January 2020, 7 patients with an average age of 68 years underwent reconstructions using a PAP flap after wide resection of STS. The mean defect size was 11.3 × 16.5 cm (range, 5.5–25 × 11–26 cm). The location of the defects was the medial thigh in 2 patients, the posterior thigh in 1, the popliteal fossa in 1, the groin in 1, and the buttock in 2. The PAP flap was elevated in the supine “frog-leg” position, the prone position, the jack-knife position, or the lateral “crisscross” position; the lateral decubitus position with the donor lower extremity on the bottom. Results: Of the 7 cases, the operations were performed in the supine “frog-leg” position in 3 cases, the prone position in 2 cases, the jack-knife position in 1 case, and the lateral “crisscross” position in 1 case. There were no intraoperative position changes in all cases. The mean size of the PAP flap was 8.7 × 19.9 cm (range, 6–11 × 17–24 cm). One patient had donor site dehiscence, which was treated conservatively. The PAP flaps survived completely in all cases. The mean follow-up period was 10.5 months (range, 6–17 months). Conclusion: Since the PAP flap elevation is feasible in every position, the PAP flap can be considered a versatile reconstruction option after sarcoma resection.

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Improved survival for extremity soft tissue sarcoma treated in high‐volume facilities

Abstract: Treatment at high-volume hospitals was associated with fewer positive margins and increased overall survival at 2, 5, and 10 years. Continued efforts should focus on optimizing the balance between patient access to specialty care and experience of the treating center.

Cited by 57 publications

References 38 publications

Defining a textbook surgical outcome for patients undergoing surgical resection of intermediate and high‐grade soft tissue sarcomas of the extremities

Defining a textbook surgical outcome for patients undergoing surgical resection of intermediate and high‐grade soft tissue sarcomas of the extremities

Soft‐tissue sarcoma in adults: An update on the current state of histiotype‐specific management in an era of personalized medicine

Use of the Profunda Femoris Artery Perforator Flap for Reconstruction after Sarcoma Resection

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