Unplanned resection of soft tissue sarcoma

Abstract

Unplanned surgery of a soft tissue sarcoma is defined as the gross removal of a tumor without appropriate preoperative imaging, biopsy, or attention to the wide surgical margin. Referrals after unplanned surgery account for between 14.7% and 53% of new patients in sarcoma centers. Treatment includes multiple modalities. It has been reported that 35e74% of residual sarcomas are found in reexcised specimens. Therefore, additional reexcision is typically warranted to remove the residual tumor and obtain an adequately safe margin. Adjuvant radiotherapy is generally used if the sarcoma is large, high grade, and deeply located. Adjuvant chemotherapy remains controversial because of its marginal benefits. A recent study indicated that adjuvant chemotherapy, an ifosfamide/epidoxorubicin protocol, showed 19% improvement in overall survival at 4 years. Therefore, adjuvant chemotherapy should be reserved for patients with a large, high-grade, localized lesion, and stage-IV disease. Unplanned surgery of high-grade sarcomas has resulted in increased rates of local recurrence but not disease-specific survival. Adequate additional reexcision may improve local control and survival. To avoid unplanned surgery of soft tissue sarcomas, guidelines have been recommended for clinicians to increase their awareness of the clinical features that suggest malignancy in any soft tissue lump.

Unplanned Sarcoma Excisions: Understanding How They Happen

“… 5 , 7 Unplanned excisions tend to occur in a community or nonspecialized sarcoma center setting, where this rare disease is seldom diagnosed or treated. 8 Once the unplanned excision has been performed and the sarcoma diagnosis rendered, the patient ought to be referred for definitive care to a center with experience in malignant soft-tissue tumors. The referred sarcoma specialist, typically an orthopaedic oncologist, and accompanying multidisciplinary team then decide the optimal treatment course.…”