Outcomes of plastic surgical reconstruction in extremity and truncal soft tissue sarcoma: Results from the US Sarcoma Collaborative

Abstract

Background: This study aimed to define how utilization of plastic surgical reconstruction (PSR) affects perioperative outcomes, locoregional recurrence-free survival (LRRFS), and overall survival (OS) after radical resection of extremity and truncal soft tissue sarcoma (ETSTS). The secondary aim was to determine factors associated with PSR.Methods: Patients who underwent resection of ETSTS between 2000 and 2016 were identified from a multi-institutional database. PSR was defined as complex primary closure requiring a plastic surgeon, skin graft, or tissue-flap reconstruction. Outcomes included PSR utilization, postoperative complications, LRRFS, and OS.Results: Of 2750 distinct operations, 1060 (38.55%) involved PSR. Tissue-flaps (854, 80.57%) were most commonly utilized. PSR was associated with a higher proportion of R0 resections (83.38% vs. 74.42%, p < 0.001). Tissue-flap PSR was associated with local wound complications (odds ratio: 1.81, confidence

When to ditch the ladder and take the elevator: The Anderson SArcoma Risk of Complications (A‐SARC) score to guide reconstructive decision‐making in extremity soft tissue sarcoma patients

“…While overall complications remained stable at approximately 10%-20% for advanced reconstruction across F I G U R E 3 A-SARC tier versus major complication rate according to reconstructive technique for all patients (n = 390). There were 42 patients with A-SARC scores considered to be low (0-2), 239 patients with A-SARC scores considered to be intermediate (3)(4)(5), and 109 patients with A-SARC scores considered to be high (≥6). There is a significantly increased major complication rate for low-risk patients undergoing an advanced method of reconstruction and for high-risk patients undergoing a simple method of reconstruction.…”

“…). There were 42 patients with A-SARC scores considered to be low (0-2), 239 patients with A-SARC scores considered to be intermediate (3)(4)(5), and 109 patients with A-SARC scores considered to be high (≥6). There is a significantly increased complication rate for intermediate and high-risk patients undergoing a simple reconstruction compared to patients with a similar degree of risk undergoing an advanced reconstruction.…”

“…Owing to the high rate of medical comorbidities and the frequent need for aggressive (neo)adjuvant therapies in eSTS patients, we have observed a high rate of wound healing complications when simple reconstructive techniques are employed, even when the reconstructive ladder suggests that an advanced method of reconstruction is not necessary 5,6 . An accurate complication risk estimation scale would be a useful tool to help inform reconstructive decision‐making and to assist in patient counseling.…”

“…Owing to the high rate of medical comorbidities and the frequent need for aggressive (neo)adjuvant therapies in eSTS patients, we have observed a high rate of wound healing complications when simple reconstructive techniques are employed, even when the reconstructive ladder suggests that an advanced method of reconstruction is not necessary. 5,6 An accurate complication risk estimation scale would be a useful tool to help inform reconstructive decision-making and to assist in patient counseling. The purpose of this study was to describe eSTS patients who will most optimally benefit from an advanced method of reconstruction (defined as a pedicled regional flap or free flap) and to create a simple risk assessment scale that can be employed in clinical practice.…”

What’s New in Musculoskeletal Tumor Surgery

“…These results highlight the need for alternative methods or risk assessment tools to accurately predict and prevent wound-healing complications in patients who had undergone preoperative irradiation of a soft-tissue sarcoma. Finally, Thalji et al analyzed the outcomes of plastic surgical reconstruction in patients with extremity and truncal soft-tissue sarcoma, using data from the U.S. Sarcoma Collaborative, and provided valuable information on the effectiveness of and complications associated with plastic surgical techniques in sarcoma treatment 63 .…”