Extremity Sarcoma Research Articles

Indications of amputation after limb-salvage surgery of patients with extremity-located bone and soft-tissue sarcomas: A retrospective clinical study.

This study aimed to investigate amputation-related factors after limb-salvage surgery (LSS) in patients with extremity-located bone and soft-tissue sarcomas and determine the relationship between these factors and patient survival. In this retrospective study at our institution, patients in whom LSS was first performed because of an extremity-located musculoskeletal sarcoma, and subsequently amputation was carried out for various indications were included. Patient and tumor characteristics, details of surgical procedures, indications of amputation, number of operations, presence of metastasis before amputation, and post-amputation patient survival rates were analyzed. A total of 25 patients (10 men, 15 women; mean age=41.96±21.88 years), in whom amputation was performed after LSS as initial resection of an extremity sarcoma or re-resection(s) of a local recurrence, were included in the study. The leading oncological indication for amputation was local recurrence that occurred in 18 (72%) patients. Non-oncological indications included prosthetic infection in 5 (20%), mechanical failure in 1 (4%), and skin necrosis in 1 (4%) patient. The patients underwent a median of 2 (range, 1-4) limb-salvage procedures before amputation. Distant organ metastasis was detected in 22 (88%) patients during follow-up; in 13 (52%) of these patients, metastasis was present before amputation. A total of 11 (44%) patients were alive at the time of study with no evidence of the disease (n=3) or with disease (n=8), and 14 (56%) patients died of disease. The mean overall and post-amputation survival were 47±20.519 (range, 11-204) months and 22±4.303 (range, 2-78) months, respectively. The median follow-up was 27 (range, 6-125) months. The most common causes of amputation after LSS were local recurrence and prosthetic infection. Patients who underwent amputation after LSS developed a high rate of distant organ metastasis during follow-up and had reduced survival. Level IV, Therapeutic Study.

Comparison of the 7th and 8th version of the AJCC classification system for soft tissue sarcomas of extremities and trunk in patients with localised, intermediate or high-grade disease treated at European tertiary sarcoma centres

BackgroundThe updated 8th version of the AJCC-staging system for soft tissue sarcomas (STS) has been criticised for omitting tumour depth as category-defining variable and eventually not improving prognostic accuracy in comparison to the 7th version. This study aimed at investigating the prognostic accuracy of both AJCC-versions in STS-patients treated at European tertiary sarcoma centres. Methods1032 patients (mean age: 60.7 ± 16.3 years; 46.0% [n = 475] females; median follow-up: 38.6 months), treated at five tertiary sarcoma centres for localised, intermediate or high-grade STS of extremities and trunk were retrospectively included. Uni- and multivariate Cox-regression models and Harrell's C-indices were calculated to analyse prognostic factors for overall survival (OS) and assess prognostic accuracy. ResultsIn univariate analysis, prognostic accuracy for OS was comparable for both AJCC-versions (C-index: 0.620 [8th] vs. 0.614 [7th]). By adding margins, age, gender, and histology to the multivariate models, prognostic accuracy of both versions could be likewise improved (C-index: 0.714 [8th] vs. 0.705 [7th]). Moreover, tumour depth did not significantly contribute to prognostic accuracy of the 8th version's multivariate model (C-index for both models: 0.714). Stratification into four main T-stages based on tumour size only, as implemented in the 8th version, significantly improved prognostic accuracy between each category. However, T-stages as defined in the 7th version had poorer discriminatory power (C-index: 0.625 [8th] vs. 0.582 [7th]). ConclusionBoth AJCC-versions perform equally well regarding prognostic accuracy. Yet, simplification of the 8 th version by omitting tumour depth as T-stage-defining parameter, whilst emphasizing the importance of tumour size, should be considered advantageous.

Cross-cultural adaptation and validation of the Musculoskeletal Tumor Society (MSTS) scoring system and Toronto Extremity Salvage Score (TESS) for musculoskeletal sarcoma patients in Greece.

PurposeTo perform translation, cross-cultural adaptation, and validation of the Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) scoring system in Greek patients with lower extremity sarcoma.MethodsThe Greek version of the MSTS for the lower extremity and TESS questionnaires was developed using previously reported methods. Included were 100 patients with musculoskeletal sarcoma who underwent limb salvage surgery. The test–retest reliability [interclass correlation coefficient (ICC) between 2 different time points], internal consistency (Cronbach’s alpha), construct validity (Kaiser’s criteria, Eigenvalue > 1 rule), and external validity (Short form-36, Spearman’s Rho) were assessed.ResultsThe test–retest reliability (ICC was 0.99 for MSTS-LE and 1 for TESS) and internal consistency were high (Cronbach’s alpha was 0.763 for MSTS-LE and 0.924 for TESS) for both questionnaires. Based on the Scree plot, the number of factors retained was 1 for MSTS-LE and 2 for TESS. The TESS showed a strong correlation with SF-36 (Spearman’s rho = 0.714, p < 0.001), but the correlation between MSTS for lower extremity and SF-36 was weak (Spearman’s Rho = 0.313, p = 0.002).ConclusionsThe Greek version of both the MSTS for lower extremity and TESS questionnaire showed sufficient reliability, internal consistency and good performance using the loading factor analysis when used postoperatively in Greek patients who underwent surgical resection of lower extremity sarcoma. However, only the TESS showed strong correlation with the SF-36, indicating that MSTS for lower extremity was not as powerful for the evaluation of the global health status of these patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00590-021-02921-5.

Analysis of mechanical complications for patients with extremity sarcoma after biological reconstruction

BackgroundBiological reconstruction after tumor resection is significant for restoration of limb integrality. However, it is unclear what risk factors influence mechanical complications of patients after extremity sarcoma resection and biological reconstruction. The objective of study was (1) to compare complications between patients receiving inactivated autograft and allograft, (2) to analyze influence of graft type, nonunion and fixation method on mechanical complications for patients after biological reconstruction. HypothesisWe hypothesized allograft, nonunion and fixation method influence occurrence of mechanical complications after biological reconstruction. Materials and methodsWe retrospectively reviewed 71 patients with sarcomas at the extremity receiving biological reconstruction from January 1999 to November 2015. Eight patients were lost at last follow-up. Sixty-three patients with complete clinical data were recruited into the present study. There were 32 males and 31 females with a mean age of 20.5±14.9 years (median, 17 years; range, 2–72 years). Sixty-one cases had tumors at lower extremity and two at upper extremity. Histological diagnosis was confirmed as forty-five with osteosarcoma, thirteen with Ewing sarcoma and five with chondrosarcoma. ResultsForty-four patients were free of disease, sixteen died of disease and three lived with pulmonary metastasis at last follow-up. Twenty-one out of 63 patients (33.3%) had local recurrence requiring surgical treatment. Reconstruction choice (mechanical complications rates were 38.9% for allograft (14/36) versus 14.8% for inactivated autograft (4/27)) and nonunion occurrence (yes 58.8% (10/17); no 17.4% (8/46)) had the close relationship with mechanical complication in the univariate analysis. The multivariate analysis revealed fixation method (p=0.041) and nonunion (p=0.008) were prognostic factors for mechanical complication of sarcoma resection and biological reconstruction at the extremity. Fourteen of 36 patients receiving massive allograft had a second surgery due to mechanical complication compared to 4 of 27 patients with massive inactivated autograft (38.9%, 14/36 vs. 14.8%, 4/27 (p=0.05)). Time to union for diaphysis and metaphysis was not significantly different between allograft and inactivated autograft groups. DiscussionPatients receiving massive allograft are prone to suffer from the mechanical complications. Extramedullary plate and nonunion have the tendency of increasing occurrence of mechanical complications of biological reconstruction. Level of Evidence: IV; retrospective study.

Long-term patient-reported outcome measures following limb salvage with complex reconstruction or amputation in the treatment of upper extremity sarcoma.

This study compares long-term patient-reported outcomes between patients that underwent limb-salvage surgery with complex reconstruction by free or pedicled flap (LS) or amputation. Additionally, the need for revision surgery is compared. A total of 43 patients were studied at a median follow-up of 9.54 years. Sixteen patients completed questionnaires regarding functional outcome and mental wellbeing. Functional outcomes were measured by using the Toronto Extremity Salvage Score (TESS), QuickDASH, and PROMIS Upper Extremity instruments. Mental wellbeing was assessed using the PROMIS Anxiety and Depression instruments. Revision surgery was assessed for the entire follow-up. The median TESS scores were 96.0 versus 71.7 (p = 0.034) and the PROMIS Upper Extremity scores were 50.1 versus 40.3 (p = 0.039) for the LS and amputation cohorts, respectively. No significant difference was found regarding symptoms of anxiety (52.7 vs. 53.8; p = 0.587) or depression (52.0 vs. 50.5; p = 0.745). Of the patients in the LS cohort 51.6% required at least one reoperation compared to 8.33% in the amputation cohort. LS surgery maintains functional benefits over amputation after almost a decade of follow-up. Still, mental wellbeing seems to be comparable between these patients, whereas LS procedures are associated with a sixfold increased need for reoperations.

Abstract PO-027: Associations of radiomics features with tumor necrosis following chemotherapy and/or radiation therapy in patients with extremity soft tissue sarcoma

Abstract Introductory sentence: The purpose of this study is to identify MRI radiomic features of sarcomas pre and post treatment with radiation and/or chemotherapy that correlate with the level of necrosis demonstrated on pathology report upon tumor excision. Experimental procedures: Patients with soft tissue upper and lower extremity sarcomas and available pre- and post-treatment MRI exams were included in the study. For the purposes of this study we utilized T2 fat saturated imaging sequences. We employed MINT Lesion radiomics software for extraction of quantitative imaging data. The lesions Regions of Interest (ROIs) were manually contoured MRI scans before and after chemotherapy and/or radiation therapy. Following treatment, patients had their tumors excised with corresponding tumor necrosis data recorded. Using Pearson correlation statistics, the percent necrosis was compared to radiomic changes (delta-radiomics). Summary of data: Fifty-two patients, treated between 2012 and 2020 were included in the study. The clinical characteristics were: male – (56%) and female- (44%); type of sarcomas ranged from Liposarcoma, Leiomyosarcoma, Myxofibrosarcoma, among others; Grade 2-3; Treatment with radiation and/or chemotherapy of different doses and regimens. MRIs were acquired within 3 months before initiation of treatment and within 2 months after treatment. Surgery was subsequently performed within 2 months of last MRI scan. The average necrosis on final pathology was 68% +/- 33% std. Total of 41 radiomic features were extracted from the ROIs. Five of the delta-radiomics parameters were significantly correlated with necrosis (p-value &amp;lt; 0.05) and sixteen were marginally associated (p-value &amp;lt; 0.1). The significantly correlated radiomic features includes first and second order values representing the distribution of voxel intensities within the segmented image regions and the statistical inter-relationships between neighboring voxels, respectively. Conclusions: In this pilot study we identified delta-radiomics features, related to first order radiomic data, or increased voxel intensity, and second order radiomics, or increased vowel heterogeneity, associated with the level of necrosis within sarcomas post radiation and/or chemotherapy. This data will be followed up with larger patient samples and including additional sequences for delta-radiomics analysis, such as Diffusion Weighted Imaging and Dynamic Enhanced Contrast to develop prediction models for necrosis levels. Citation Format: James Grosso, Ty Subhawong, Radka Stoyanova, Raphael Yechieli, Crystal Seldon, Blase Prosperi. Associations of radiomics features with tumor necrosis following chemotherapy and/or radiation therapy in patients with extremity soft tissue sarcoma [abstract]. In: Proceedings of the AACR Virtual Special Conference on Artificial Intelligence, Diagnosis, and Imaging; 2021 Jan 13-14. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(5_Suppl):Abstract nr PO-027.

Willingness of patients with sarcoma to participate in cancer surveillance research: a cross-sectional patient survey

ObjectivesTo determine the proportion of patients with extremity sarcoma who would be willing to participate in a clinical trial in which they would be randomised to one of four different...

Diagnosis and management of primary malignant tumors in the upper extremity

Bone and soft tissue sarcomas of the upper extremity are relatively uncommon. In many cases, they are discovered incidentally during evaluation of traumatic injuries or common ailments such as rotator cuff tendonitis or tennis elbow. Thus, it is important for all orthopedic surgeons to understand the differential diagnosis, workup, and treatment for upper extremity lesions. An appreciation of the clinical and radiographic features of primary malignant lesions aids in identifying patients that need referral to an orthopedic oncologist and a multidisciplinary team.

Ovarian stimulation for fertility preservation in an oncology patient with etonogestrel implant in place.

To describe a case of a young woman who presented for fertility preservation and underwent ovarian stimulation with an etonogestrel implant in place. A 24-year old, gravida 0, with an etonogestrel implant and newly diagnosed lower extremity sarcoma and DVT desiring oocyte cryopreservation prior to adjuvant chemotherapy and radiation. To avoid delay in her oncologic care and allow for continued use of contraception post-retrieval, the patient underwent controlled ovarian hyperstimulation (COH) without removal of the etonogestrel implant. Baseline labs included follicle-stimulating hormone 9 mIU/mL, luteinizing hormone 4.9 mIU/mL, estradiol 42 pg/mL, anti-Müllerian hormone 5.1 ng/mL, and antral follicle count greater than 40. The patient was placed on an antagonist protocol and stimulated with 125 IU Gonal-F and 75 IU Menopur. She received a total of 12 days of gonadotropin stimulation. On the day of trigger, her estradiol was 1472 pg/mL, lead follicle 21.5 mm with a total of 25 follicles measured > 12 mm. She was triggered with 5000 U hCG. She had a total of 23 oocytes retrieved, 17 of which were metaphase II and vitrified. COH and successful oocyte cryopreservation can be achieved in patients with an etonogestrel implant in situ without apparent detrimental effects to oocyte yield or maturity. Due to the etonogestrel implant's inhibitory effects on LH, it is recommended to use an hCG trigger for final oocyte maturation.

Demography and Short Term Functional Outcome of Soft Tissue Sarcoma Treated with Limb Salvage Surgery

Background: Limb salvage surgery with or without radiotherapy and/or chemotherapy is the mainstay of treatment of Soft Tissue Sarcoma (STS). Though, many studies are found regarding the demographics and result of such malignancy from other parts of the world, such data is not available from our country. This study aimed to analyze the demographic data and functional outcome of STS treated with limb salvage surgery.&#x0D; Methods: It is a retrospective review of 16 cases of soft tissue sarcoma of extremities and trunk managed with limb salvage surgery followed by adjuvant radiotherapy and/or chemotherapy in indicated cases from 2012 to 2017. Demographic data and functional score after 2 years of surgery were analysed and presented.&#x0D; Results: There were 14 male and 2 female cases of STS with mean age of 32.88 years. The most common STS was liposarcoma (37.5%) followed by rhabdomyosarcoma (25%) and synovial sarcoma (18.8%). Extremity and lower limb were the most common sites. Mean MSTS functional score at the last follow up was 24.56 (81.83%) with range from 19-29 (63.33%-96.66%). There were good to excellent results in 13 cases (81.25%) and moderate result in 3 cases (18.75%) according to MSTS functional score. There was positive correlation of MSTS with age, radiotherapy, chemotherapy and negative correlation with grade of tumor.&#x0D; Conclusions: This study showed good to excellent functional results in 81.25% of cases as per Musculoskeletal Tumor Society Score (MSTS) with positive correlation with radiotherapy, chemotherapy, age and negative correlation with grade of tumor.

Factors associated with 30‐day soft tissue complications following upper extremity sarcoma surgery

The incidence of soft tissue complications following sarcoma surgery in the upper extremity is reportedly high. Therefore, this study assessed the National Surgical Quality Improvement Program (NSQIP) database to identify independent risk factors, while also reporting the incidence of soft tissue complications in the first 30 days after surgery. A total of 620 patients that underwent surgical treatment for upper extremity sarcoma were included from the NSQIP database. Soft tissue complications were defined as surgical site infection, wound dehiscence, or soft-tissue related reoperations. Clinically relevant patient and treatment characteristics were selected and analyzed. The 30-day soft tissue complication rate was 4.7%. In the multivariable analysis, higher body mass index (p = .047) and longer operative times (p = .002) were independently associated with soft tissue complications. Higher body mass index and longer operative times are risk factors for soft tissue complications following upper extremity sarcoma surgery. The soft-tissue complication rate following resection of upper extremity tumors is low in this national cohort, possibly due to the relatively small tumor size and low prevalence of radiotherapy.

Efficacy of hyperthermic isolated limb perfusion in the treatment of locally recurrent high-grade soft tissue sarcoma of the extremities

BackgroundThis novel study compared the use of tumor necrosis factor (TNF)-alpha and melphalan-based isolated limb perfusion (TM-ILP) to the standard treatment of locally recurrent soft tissue extremity sarcoma. The aim was to assess whether TM-ILP positively influences the recurrence-free survival of locally recurrent high-grade soft tissue sarcoma (STS) of the extremities.MethodsWe retrospectively analyzed our clinical database for patients with STS. Variables were analyzed using chi-square test or Mann-Whitney rank-sum test. Furthermore, Kaplan-Meier survival plots were calculated and a proportional hazard regression model was developed.ResultsOut of 448 patients with extraabdominal STS treated between August 2012 and December 2015, 52 cases involving 47 patients had locally recurrent STS. Twenty-eight of these patients were treated with TM-ILP prior to surgical resection (TM-ILP-group), and 24 were treated with standard therapy (without TM-ILP). The 3-year recurrence-free survival for the TM-ILP-group was estimated at 75% (95% confidence interval (CI), 71.5–78.5). Local recurrence-free survival in the standard group was significantly lower (LRFS: 43.4%, 95% CI 38.7–48.1, p = 0.026). Multivariable analysis revealed resection with negative margins, lower number of previous recurrences, and TM-ILP as positive predictors for recurrence-free survival.ConclusionsTM-ILP and consecutive resection of residual tumor with negative resection margins significantly improves local recurrence-free survival for patients with a first local recurrence of high-grade STS in the extremities.

Impact of resection margin on outcomes in high-grade soft tissue sarcomas of the extremity-A USSC analysis.

The optimal margin of resection for high-grade extremity sarcomas and its impact on survival has long been questioned in the setting of adjuvant radiotherapy. The objective of this study was to investigate the impact of resection status on recurrence and survival. All patients with primary, nonmetastatic, high-grade extremity sarcomas that underwent surgical resection from January 2000 to April 2016 in the U.S. Sarcoma Collaborative (USSC) were retrospectively reviewed. Recurrence patterns, recurrence-free survival (RFS), and overall survival (OS) were examined in multivariate analyses (MVA). A cohort of 959 patients was identified with a median follow-up of 34.7 months from diagnosis. R0 resection was achieved in 86.7% (831) while R1 resection in 13.3% (128). Locoregional recurrence for R0 and R1 groups occurred in 9.1% (76) versus 14.8% (19; p = .05) while distant recurrence occurred in 24.7% (205) versus 26.6% (34; p = .65), respectively. Median RFS was 171.2 versus 48.5 (p = .01) while median OS was 149.8 versus 71.5 months (p = .02) for the R0 versus R1 group, respectively. On MVA, female gender (hazard ratio [HR] = 0.69, p = .007) and adjuvant radiotherapy (0.7, p = .04) were associated with improved OS, whereas older age (HR = 1.03, p < .001) and tumor size (HR = 1.01, p < .001) were associated with worse OS. R0 resection status was associated with improved locoregional RFS (HR = 0.56, p = .03) but not with distant RFS (HR = 0.84, p = .4) or OS (HR = 0.7, p = .052). In high-grade extremity sarcomas, tumor size and gender are predictive of OS while R0 resection status is associated with improved locoregional recurrence rate without a significant impact on distant RFS or OS.

Treatment options in unresectable soft tissue and bone sarcoma of the extremities and pelvis - a systematic literature review.

In patients with metastatic or unresectable soft tissue and bone sarcoma of extremities and pelvis, survival is generally poor. The aim of the current systematic review was to analyse recent publications on treatment approaches in patients with inoperable and/or metastatic sarcoma.Original articles published between 1st January 2011 and 2nd May 2020, using the search terms ‘unresectable sarcoma’, ‘inoperability AND sarcoma’, ‘inoperab* AND sarcoma’, and ‘treatment AND unresectable AND sarcoma’ in PubMed, were potentially eligible. Out of the 839 initial articles (containing 274 duplicates) obtained and 23 further articles identified by cross-reference checking, 588 were screened, of which 447 articles were removed not meeting the inclusion criteria. A further 54 articles were excluded following full-text assessment, resulting in 87 articles finally being analysed.Of the 87 articles, 38 were retrospective (43.7%), two prospective (2.3%), six phase I or I/II trials (6.9%), 22 phase II non-randomized trials (27.6%), nine phase II randomized trials (10.3%) and eight phase III randomized trials (9.2%). Besides radio/particle therapy, isolated limb perfusion and conventional chemotherapy, novel therapeutic approaches, including immune checkpoint inhibitors and tyrosine kinase inhibitors were also identified, with partially very promising effects in advanced sarcomas.Management of inoperable, advanced or metastatic sarcomas of the pelvis and extremities remains challenging, with the optimal treatment to be defined individually. Besides conventional chemotherapy, some novel therapeutic approaches have promising effects in both bone and soft tissue subtypes. Considering that only a small proportion of studies were randomized, the clinical evidence currently remains moderate and thus calls for further large, randomized clinical trials.Cite this article: EFORT Open Rev 2020;5:799-814. DOI: 10.1302/2058-5241.5.200069

OC-0087: Preoperative Hypofractionated Radiation Therapy for Soft Tissue Sarcomas of Extremity and Trunk

OC-0087: Preoperative Hypofractionated Radiation Therapy for Soft Tissue Sarcomas of Extremity and Trunk

Femoral Fracture in Primary Soft Tissue Sarcoma Treated with Intensity-Modulated Radiation Therapy with and Without Dose Constraints.

We previously reported that the cumulative risk of femoral fracture in patients treated with intensity-modulated radiation therapy (IMRT) for thigh and groin soft tissue sarcoma (STS) is low. In the current study, we sought to evaluate the effect of radiation dose constraints on the rate of femoral fracture in a more contemporary cohort. All patients treated with IMRT for STS of the thigh or groin from 2004 to 2016 were included (n=145). Beginning in 2011, radiation dose was constrained to a mean dose of < 37Gy, volume of bone receiving ≥ 40Gy (V40Gy) < 64%, and maximum dose < 59 Gy to limit the dose to the femur. Sixty-one patients were treated before dose constraints were implemented, and 84 patients were treated after. Median follow-up for patients treated before and after constraints were implemented was 6.1 and 5.7years, respectively, and the two groups were demographically and clinically similar. On univariate analysis, the 5-year cumulative incidence of femoral fracture among patients treated with and without dose constraints was 1.8% (95% confidence interval [CI] 0.3-12.2%) versus 7.4% (95% CI 3.1-17.6%) [p=0.11, p=non-significant, respectively]. On multivariable analysis, only age ≥ 60years was significantly associated with increased risk of fracture. The risk of femoral fracture after IMRT for STS of the thigh/groin is low, and with the implementation of radiation dose constraints, the risk is < 2%. Although longer follow-up is needed, our results support the utilization of extremity sarcoma IMRT-specific dose constraints for fracture prevention.

Intraoperative Localization Using an Implanted Radar Reflector Facilitates Resection of Non-Palpable Trunk and Extremity Sarcoma.

Resecting non-palpable soft tissue tumors presents a unique challenge, particularly with recurrent disease in which surrounding tissue has been surgically manipulated and often irradiated. SAVI SCOUT® is a radar-based localization device that was developed for breast tumor localization and was recently FDA-approved for localization of soft tissue tumors. Application of this technology to soft tissue sarcoma has not been previously reported. We assembled a single-institution retrospective case series of patients with trunk and extremity sarcomas resected by five sarcoma surgeons using SAVI SCOUT® from December 2018 to May 2020. Reflectors were placed preoperatively using image-guidance, and the radar detector was used intraoperatively to localize the target lesion. Clinical variables were abstracted from the electronic medical record including treatment history, pathology, and early oncologic outcomes. Using a focused review, we compared margin status and recurrence rates with previously published cohorts. Ten SAVI SCOUT®-localized sarcoma resections were performed. Eight were for locally recurrent disease, of which seven (83%) had prior radiation. The remaining lesions became non-palpable after neoadjuvant chemotherapy. SAVI SCOUT® facilitated resection in all cases with a margin-negative resection rate (77%) comparable to prior cohorts. In this high-risk population with a median follow-up of 14months, only one patient recurred locally 7.5months after SAVI SCOUT®-localized resection, requiring re-resection. SAVI SCOUT® technology facilitated resection of non-palpable recurrent sarcoma of the trunk and extremities in all ten cases attempted. In a high-risk patient population, the pattern of recurrence has been primarily distant with one instance of local tumor recurrence.

Factors Associated With 30-day Soft Tissue Complications and Reoperation Following Upper Extremity Sarcoma Surgery

PURPOSE: To identify risk factors for the occurrence of 30-day soft tissue complications and reoperations following upper extremity sarcoma excision. NULL HYPOTHESIS: There are no pre- or perioperative factors associated with a soft tissue complication or reoperation during the first 30 days following upper extremity sarcoma surgery. N AND FOLLOW-UP: Six hundred twenty patients, 30-day postoperative follow-up. METHODS: Using the American College of Surgeons National Surgery Quality Improvement Program (NSQIP)1 database, a total of 620 patients were identified who underwent surgical treatment of an upper extremity (UE) sarcoma between 2005 and 2018. The primary outcomes were the 30-day occurrence of a soft tissue complication (including surgical site infections, wound dehiscence, and soft tissue-related reoperations) and any unplanned reoperation. The median age was 62.5 years (interquartile range [IQR], 49–73), and most tumors were soft tissue sarcomas (n = 496; 80%) with the upper arm being the most commonly affected location (n = 424; 68%). Tumor extirpation was the most common surgical treatment (n = 559; 90%), and amputation was performed in 61 patients (10%). To evaluate the factors associated with reoperation, a bivariate analysis was performed, and to evaluate the factors associated with soft tissue complication, a multivariable analysis was performed. RESULTS: The 30-day soft tissue complication rate was 4.7%, and the 30-day unplanned reoperation rate was 5.5%. The reoperation rate was higher in patients who underwent preoperative radiotherapy (30% versus 6.1%; P = 0.027) and in those with longer operative times (median, 129 minutes [IQR, 59–280] versus 88 minutes [IQR, 50–156]; P = 0.035). Soft tissue complications were more common in patients with a higher BMI (β = 0.048; P = 0.047) and following longer operations (β = 0.003; P = 0.002) based on the multivariable analysis. In the subset of patients who underwent soft tissue tumor extirpation (n = 451), bivariate analysis of tumor characteristics showed that a tumor size ≥5 cm (12% versus 3.8%; P = 0.015) was associated with a soft tissue complication. CONCLUSIONS: The risk of developing a soft tissue complication or undergoing an unplanned reoperation is approximately 1 in 20 following upper extremity sarcoma surgery. Longer operative time and patients with a higher BMI are at higher odds of developing a soft tissue complication following upper extremity sarcoma surgery. Preoperative radiotherapy and longer operative procedures are risk factors for unplanned reoperations. Larger tumor size seems to be a risk factor in developing a soft tissue complication following tumor extirpation. REFERENCE: 1. About ACS NSQIP. https://www.facs.org/quality-programs/acs-nsqip/about. Accessed February 23, 2020.

Surgical resection, intraoperative radiotherapy and immediate plastic reconstruction: A good option for the treatment of distal extremity soft tissue sarcomas.

To show three patients with soft tissue sarcomas of distal extremities conservatively treated after tumor-board discussion, involving margin-free surgery, exclusive intraoperative radiotherapy, and immediate reconstruction. Current guidelines show clear and robust recommendations regarding the composition of the treatment of sarcomas of extremities. However, little evidence exists regarding the application of these treatments depending on the location of the primary neoplasia. Tumors that affect the distal extremities present different challenges and make multidisciplinary discussions desirable. We reported 3 patients who were approached with a conservative intention, after tumor board recomendation. The goals from the treatment performed were aesthetic and functional preservation, while enruring locoregional control. We had wound healing complications in 2 of the cases, requiring additional reconstruction measures. Patients are followed up for 24, 20 and 10 months; local control is 100%, and functional preservation is 100%. Despite being a small series, it was sufficient to illustrate successful multidisciplinary planning, generating a therapeutic result with improved quality of life for patients who had an initial indication for extremity amputation.

Postoperative Outcomes and Practice Patterns in Extremity Sarcoma Management by Surgeon Specialty over Time: A National Cohort Study

Postoperative Outcomes and Practice Patterns in Extremity Sarcoma Management by Surgeon Specialty over Time: A National Cohort Study