Incomplete excisions of extremity soft tissue sarcomas are unaffected by insurance status or distance from a sarcoma center

Alamanda, Vignesh K.; Delisca, Gadini O.; Archer, Kristin R.; Song, Yanna; Schwartz, Herbert S.; Holt, Ginger E.

doi:10.1002/jso.23427

Cited by 17 publications

(13 citation statements)

References 25 publications

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“…The upper extremity is a more frequent site for unplanned excision (35.4%) than it is for planned excision (22.5%) (p < 0.05) 19 ; however, other investigators have reported the knee to be the most common site 15 . Most authors have reported unplanned excisions to be more common in patients with superficial tumors 11 .…”

Section: Locationmentioning

confidence: 97%

“…Alamanda et al 19 compared 253 patients undergoing planned excision with 147 patients undergoing reexcision after unplanned excision of soft-tissue sarcomas and found that distance from a sarcoma center (p = 0.69) and insurance status (p = 0.43) were not risk factors for unplanned excision.…”

Section: Insurance Status and Distance From A Sarcoma Centermentioning

confidence: 99%

“…Alamanda et al 19 showed that patients with unplanned excision presented with earlier stage disease than did patients with planned excision (63.7% who had unplanned excision had American Joint Committee on Cancer stage I and II compared with 39.7% who had primary excision; p < 0.05).…”

Section: Stagementioning

confidence: 99%

“…Size Unplanned excision is more likely to be performed in patients with a smaller tumor (median size, 5 cm) than in those who have planned excision (median size, 12 cm) (p < 0.05) 19 .…”

Section: Tumor Characteristicsmentioning

confidence: 99%

“…The most common pathologic diagnoses following unplanned excisions are synovial sarcoma 17,20 , malignant fibrous histiocytoma 18 , and intermediate or high-grade liposarcomas 19 .…”

Section: Diagnosis and Histological Findingsmentioning

confidence: 99%

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Unplanned Excision of Soft-Tissue Sarcomas

Pretell-Mazzini

Barton

Conway

et al. 2015

The Journal of Bone and Joint Surgery

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➤ Biopsy, staging, preoperative imaging and planning, as well as surgical treatment of soft-tissue sarcomas, are best carried out in specialized sarcoma centers, with the support of a multidisciplinary tumor board.➤ Tumor bed excision is recommended after most unplanned excisions, with a goal of obtaining complete tumor removal with an appropriately wide margin of resection.➤ The surgical resection area tends to be more extensive during tumor bed excision than during primary resection because of the need to resect potential areas of contamination, resulting in the need for more reconstructive procedures (flaps and skin grafts) and wider radiation fields.➤ Unplanned excisions are associated with an increased rate of local recurrence related to residual disease and positive margins after tumor bed excision, a deep location, and certain histologic subtypes, such as malignant peripheral nerve sheath tumor, myxofibrosarcoma, and dermatofibrosarcoma protuberans.➤ While adjuvant radiation therapy has not been found to mitigate the risk of local recurrence in unplanned excisions, it is generally utilized in the treatment of unplanned excisions as it is in the treatment of primary soft-tissue sarcomas.➤ Given the surgical and oncologic sequelae of unplanned excisions, prevention through the diffusion of concepts by means of provider education on how to approach soft-tissue masses, which can be potential soft-tissue sarcomas, is the best strategy.

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Section: Locationmentioning

confidence: 97%

Section: Insurance Status and Distance From A Sarcoma Centermentioning

confidence: 99%

Section: Stagementioning

confidence: 99%

“…Size Unplanned excision is more likely to be performed in patients with a smaller tumor (median size, 5 cm) than in those who have planned excision (median size, 12 cm) (p < 0.05) 19 .…”

Section: Tumor Characteristicsmentioning

confidence: 99%

“…The most common pathologic diagnoses following unplanned excisions are synovial sarcoma 17,20 , malignant fibrous histiocytoma 18 , and intermediate or high-grade liposarcomas 19 .…”

Section: Diagnosis and Histological Findingsmentioning

confidence: 99%

See 3 more Smart Citations

Unplanned Excision of Soft-Tissue Sarcomas

Pretell-Mazzini

Barton

Conway

et al. 2015

The Journal of Bone and Joint Surgery

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Multidisciplinary Approach to Salvage of Unplanned Sarcoma Resections

Tedesco¹,

Henshaw

2017

Sarcoma

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Local recurrence of soft-tissue sarcoma: issues in imaging surveillance strategy

et al. 2018

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Soft-tissue sarcomas pose diagnostic and therapeutic challenges to physicians, owing to the large number of subtypes, aggressive tumor biology, lack of consensus on management, and controversy surrounding interval and duration of surveillance scans. Advances in multidisciplinary management have improved the care of sarcoma patients, but controversy remains regarding strategies for surveillance following definitive local control. This review provides an updated, comprehensive overview of the current understanding of the risk of local recurrence of soft-tissue sarcoma, by examining the literature based on features such as histological type and grade, tumor size, and resection margin status, with the aim of helping clinicians, surgeons, and radiologists to develop a tailored approach to local imaging surveillance.

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Incomplete excisions of extremity soft tissue sarcomas are unaffected by insurance status or distance from a sarcoma center

Abstract: Inappropriate excision of STS is not influenced by patient distance from a sarcoma center or by a patient's insurance status. In this study, tumor size, depth, and certain histology types predicted the appropriate referral of a STS to a sarcoma center.

Cited by 17 publications

References 25 publications

Unplanned Excision of Soft-Tissue Sarcomas

Unplanned Excision of Soft-Tissue Sarcomas

Multidisciplinary Approach to Salvage of Unplanned Sarcoma Resections

Local recurrence of soft-tissue sarcoma: issues in imaging surveillance strategy

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