Abstract
Unplanned excision of soft tissue sarcomas (STSs) outside comprehensive tumor management centers necessitates the need for wide reexcision to achieve adequate margins. We retrospectively reviewed medical records of 135 patients with STS operated at our hospital with the goal of examining outcomes, in terms of local recurrence (LR) and metastasis rate (MR), of reexcision following unplanned excision of STS and comparing results with those of first-time planned surgery. Eighty-four patients had their first-time surgery and 51 patients had come to us following unplanned excision at prereferral hospital. Mean age of all patients was 41.8 ± 21.9 years. The LR and MR was 14.3% and 8.3%, respectively, in patients undergoing first resection, whereas it was 21.4% and 13.7%, respectively, in patients undergoing revision surgery. Average duration from previous unplanned excision was 8 months. Twelve patients were referred immediately after excised specimen revealed STS, while 39 patients presented after evident local recurrence. Wide reexcision was attempted in 48 patients while three patients need amputation. Adjuvant radiotherapy was administered in all patients undergoing limb-sparing surgery. Ten patients needed adjuvant chemotherapy. We conclude that wide reexcision of STS has poorer outcomes compared to planned excision. Therefore, patients with soft tissue masses should be managed by multidisciplinary oncology team at specialized cancer centers.
Highlights
Soft tissue sarcomas (STSs) are heterogeneous groups of malignant mesenchymal tumors which comprise less than 1% of all malignancies [1]
The purpose of this study was to examine the outcomes of reexcision of residual STSs following an unplanned excision and compare it, in terms of local recurrence and metastasis, with outcomes of patients who underwent a single, planned excision
Histological diagnosis of tumor was made by taking biopsies as recommended by NCCN guidelines. pleomorphic liposarcoma, synovial cell sarcoma, spindle cell sarcoma, and malignant fibrous histiocytoma were the most common tumor types
Summary
Soft tissue sarcomas (STSs) are heterogeneous groups of malignant mesenchymal tumors which comprise less than 1% of all malignancies [1]. The literature has reported that a general physician may see one STS case in 24 years [2]. Meticulous workup in terms of radiological and histopathological evaluation is required for diagnosis and planning a multidisciplinary treatment strategy. Due to rarity of soft tissue sarcomas coupled with low index of suspicion for malignancy, these soft tissue masses are not evaluated properly by radiological and histopathological examination by general orthopedic surgeons. Bhurgri et al [6] reported that STS in Pakistan accounted for 2.9% and 1.6% of all cancers in males and females, respectively. In a country of 180 million people, we only have three trained orthopedic oncology surgeons. Such masses are excised by inexperienced surgeons without consideration of malignancy. The risk of residual disease after such unplanned excision is reported to be between 24%–60% in the literature [7,8,9,10,11,12]
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