Monitoring the Adequacy of Surgical Margins After Resection of Bone and Soft-Tissue Sarcoma

Abstract

Local recurrence of a bone or soft-tissue sarcoma is a devastating complication. Minimizing the proportion of positive surgical margins, or tumor contamination, during resection is of paramount importance. Resections of sarcomas were prospectively evaluated and considered inadequate if unplanned microscopic or macroscopic positive surgical margins were identified or if inadvertent tumor contamination of the wound occurred. Monitoring of performance was continuously performed with a statistical process control method, the cumulative sum test, and regular meetings were held to discuss the reasons for failures. A target performance of 5% inadequate procedures was chosen. A total of 146 sarcomas-106 soft tissue and 40 bone-were resected during the monitoring period. Six (4%) procedures were considered inadequate: three patients had inadvertent tumor contamination of the wound, two patients had unplanned microscopic positive margins, and one patient had both. Performance was considered to be adequate during the whole monitoring period. With adequate preoperative planning and surgical technique, the risk of an inadequate resection can be limited. Implementation of a statistical process control method allows for ongoing performance monitoring and ensures that quality remains adequate over time.