Six-Week Interval Between Preoperative Radiation and Surgery Is Associated With Fewer Major Wound Complications in Soft Tissue Sarcoma

Abstract

Objectives: A total of 30% to 40% of soft tissue sarcoma (STS) patients develop major wound complications (MWCs) after preoperative radiation (preRT). The optimal preRT-surgery interval and its association with MWCs is unknown. This study investigated whether a longer preRT-surgery interval is associated with fewer MWCs compared with historical controls. Methods: All patients treated by a single surgeon after preRT with limb-sparing wide resection for extremity and trunk STS were retrospectively reviewed from 2004 to 2014. The primary outcome was MWCs defined as a secondary operation, invasive procedure, wound packing, or readmission for wound care. Secondary outcomes of local recurrence and survival were followed and independent variables were analyzed for an association with MWCs. Results: Fifty-four patients were included with a median follow-up of 32 months and age of 61 years. The majority of tumors were deep (91%), large (median size of 11 cm), high grade (78%) and within the lower extremity (78%). The median preRT-surgery interval was 43 days and 80% of patients received surgery 35 to 49 days after radiation. MWCs were observed in 15% of patients and 88% occurred within 40 days. Predictors for MWCs on multivariate analysis were peripheral vascular disease (P=0.03), location in the medial compartment of the thigh (P=0.03), and neurovascular involvement (P=0.03). Conclusions: This study presents a cohort of STS patients with an extended preRT-surgery interval of ~6 weeks. MWCs in this population occurred at a lower rate than historical controls. Overall these findings support the exploration of a longer interval to reduce MWCs and their associated morbidity.

Risk factors associated with 30‐day complications following lower extremity sarcoma surgery: A national surgical quality improvement project analysis

“…The soft tissue complication rate in our study was found to be lower compared to the current literature, where rates range from 10.6% to 41% 17–20 . In addition, several studies investigating soft tissue sarcomas specifically, have found an association between increased sarcoma size and incidence of surgical complications 21–23 .…”

“…The soft tissue complication rate in our study was found to be lower compared to the current literature, where rates range from 10.6% to 41%. [17][18][19][20] In addition, several studies investigating soft tissue sarcomas specifically, have found an association between increased sarcoma size and incidence of surgical complications. [21][22][23] Larger tumors require a corresponding larger resection or excision procedure, which leads to an increase in dead space volume and greater potential for the development of seroma, hematoma, or devitalized tissue.…”

Strategies for care of patients with gastrointestinal stromal tumor or soft tissue sarcoma during COVID‐19 pandemic: A guide for surgical oncologists

“…A recent meta-analysis of 21 studies and more than 5,000 patients operated for extremity STS, identified an overall wound complication rate of 30% and a reoperation rate of 13%. [42][43][44] The type of surgical procedure strongly influences postoperative complications rate and resource burden. For example, in a study of 78 patients who underwent hindquarter amputation wound complication rate was 49%, in-hospital mortality was 6%, and median hospital stay was 24 days.…”

“…A recent meta‐analysis of 21 studies and more than 5,000 patients operated for extremity STS, identified an overall wound complication rate of 30% and a reoperation rate of 13% 42‐44 . The type of surgical procedure strongly influences postoperative complications rate and resource burden.…”

Transcutaneous Oximetry Does Not Reliably Predict Wound-healing Complications in Preoperatively Radiated Soft Tissue Sarcoma

“…Soft tissue sarcoma is most often treated with preoperative radiotherapy followed by surgery for local control [1,[8][9][10]12]. Radiation is preferred before surgery, as the functional results of the salvaged limb have been demonstrated to be superior when compared with radiation administered after surgery [10,13].…”