Abstract
This study aimed to compare the oncological results between unplanned excision (UE) and planned excision (PE) of malignant soft tissue tumor and to examine the impact of residual tumor (ReT) after UE. Nonmetastatic soft tissue sarcomas surgically treated in 1996–2012 were included in this study. Disease‐specific survival (DSS), metastasis‐free survival (MFS), and local‐recurrence‐free survival (LRFS) were stratified according to the tumor location and American Joint Committee on Cancer Classification 7th edition stage. Independent prognostic parameters were identified by Cox proportional hazard models. Two‐hundred and ninety PEs and 161 UEs were identified. Significant difference in oncological outcome was observed only for LRFS probability of retroperitoneal sarcomas (5‐year LRFS: 33.0% [UE] vs. 71.0% [PE], P = 0.018). Among the 142 UEs of extremity and trunk, ReT in re‐excision specimen were found in 75 cases (53%). UEs with ReT had significantly lower survival probabilities and a higher amputation rate than UEs without ReT (5‐year DSS: 68.8% vs. 92%, P < 0.001; MFS: 56.1% vs. 90.9%, P < 0.001; LRFS: 75.8% vs. 98.4%, P = <0.001; amputation rate 18.5% vs. 1.8%, P = 0.003). The presence of ReT was an independent poor prognostic predictor for DSS, MFS, and LRFS with hazard ratios of 2.02 (95% confidence interval (CI), 1.25–3.26), 1.62 (95% CI, 1.05–2.51) and 1.94 (95% CI, 1.05–3.59), respectively. Soft tissue sarcomas should be treated in specialized centers and UE should be avoided because of its detrimental effect especially when ReT remains after UE.
Highlights
Sarcomas are rare malignancies that arise from mesenchymal cells, which occur with an incidence of 2–4 per 100,000 population
Five hundred and thirty-o ne surgically treated soft tissue sarcomas were identified from the database
Forty patients had antecedent metastasis, 25 patients were properly treated with wide surgical margin and referred after recurrence, nine cases had follow-up period shorter than 2 years, and six patients had no tumor size
Summary
Sarcomas are rare malignancies that arise from mesenchymal cells, which occur with an incidence of 2–4 per 100,000 population. 71% of soft tissue sarcomas are subjected to inadvertent surgery prior to referral to specialized tumor centers [1,2,3,4,5]. Unplanned sarcoma excision has been variously described in the literatures [6,7,8,9,10]. This type of surgery refers to the removal of a mass without prior knowledge of the malignant nature of the tumor and without the application of planned oncologic margins appropriate for a sarcoma. When referred to a tumor center, re-excision after unplanned surgery is routinely performed to mitigate the possibility of residual tumor in the previous surgical
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