The effect of an unplanned excision of a soft-tissue sarcoma on prognosis

Abstract

We investigated whether our policy of routine re-excision of the tumour bed after an unplanned excision of a soft-tissue sarcoma was justified. Between April 1982 and December 2005, 2201 patients were referred to our hospital with the diagnosis of soft-tissue sarcoma, of whom 402 (18%) had undergone an unplanned excision elsewhere. A total of 363 (16.5%) were included in this study. Each patient was routinely restaged and the original histology was reviewed. Re-excision was undertaken in 316 (87%). We analysed the patient, tumour and treatment factors in relation to local control, metastasis and overall survival. Residual tumour was found in 188 patients (59%). There was thus no residual disease in 128 patients of whom 10% (13) went on to develop a local recurrence. In 149 patients (47%), the re-excision specimen contained residual tumour, but it had been widely excised. Local recurrence occurred in 30 of these patients (20%). In 39 patients (12%), residual tumour was present in a marginal resection specimen. Of these, 46% (18) developed a local recurrence. A final positive margin in a high-grade tumour had a 60% risk of local recurrence even with post-operative radiotherapy. Metastases developed in 24% (86). The overall survival was 77% at five years. Survival was related to the grade of the tumour and the finding of residual tumour at the time of re-excision. We concluded that our policy of routine re-excision after unplanned excision of soft-tissue sarcoma was justified in view of the high risk of finding residual tumour.

Short-term follow-up MRI after unplanned resection of malignant soft-tissue tumours; quantitative measurements on dynamic contrast enhanced and diffusion-weighted MR images

“…Conventional MR sequences included T 1 weighted [repetition time (TR)/echo time (TE), 400-765/9.6-12 ms; echo train length [3][4][5] and T 2 weighted (TR/TE 2600-4500/60-127 ms, ETL 15) fast spin-echo sequences using variable planes, including at least two orthogonal planes with fat suppression on at least one T 2 weighted image plane. Field of view (FOV) and matrix size were chosen based on lesion location and size.…”

“…2 Marginal excisions frequently result in residual tumour in the tumour bed, with rates ranging from 23 to 59%. [2][3][4] When there is a considerable load of residual sarcoma in the wound, additional wide resection has been recommended. 2 However, it is difficult to determine the amount of tumour remaining, because postoperative changes may share many of the characteristics of tumours on conventional MR images.…”

Synovial sarcoma in patients under 20 years of age: A multicenter study with a minimum follow-up of 10 years

“…A significant number of excised lumps after an unplanned excision unexpectedly turn out to be sarcomas [3]. Most present with a painful lump which gradually grows over time.…”

What Are Risk Factors for Local Recurrence of Deep High-grade Soft-tissue Sarcomas?

“…Whether patients undergoing unplanned excision of their primary sarcoma have a higher risk of local recurrence is controversial [2,4,10,13]. Several studies suggest unplanned excisions of soft-tissue sarcomas result in increased rates of local recurrence, mainly because of residual tumor [4,10].…”

“…Several studies suggest unplanned excisions of soft-tissue sarcomas result in increased rates of local recurrence, mainly because of residual tumor [4,10]. While patients with unplanned excisions tend to have superficial tumors, other reports show no adverse impact of unplanned excision on local recurrence [2,13].…”