Abstract
Background
Unplanned excision of soft tissue sarcoma (STS) accounts for up to 40% of all initial operations for STS and is undertaken when the mass is presumed to be benign. The effect this has on outcome has never been fully established.
Methods
Patients with extremity or trunk STS between 2001 and 2005 who were treated by an initial inadvertent operation and then referred immediately to our unit were identified. Outcomes were compared with a control group of patients with STS who were stage-matched and had been treated conventionally by core biopsy and definitive surgery. Endpoints were local recurrence, distant metastases and sarcoma-specific survival.
Results
134 patients who had undergone unplanned excision of STS were identified. One hundred twenty-one underwent further re-excision, and 51 (48%) of these patients had residual tumour identified after surgical re-excision. Two hundred nine stage-matched controls were identified who were treated conventionally. Median follow-up was 51.6 months. Local recurrence rates were considerably higher in the study group (23.8 vs. 11%, p = 0.0016), despite the control group having more stage 3 tumours. When the tumours were matched by stage, an increase in local recurrence was seen across all stages but was most pronounced for stage 3 tumours (37.5 vs. 14.2%, p = 0.005). Metastasis-free and sarcoma-specific survival were also significantly increased for stage 3 tumours.
Conclusion
Unplanned initial excision of extremity soft tissue sarcoma may compromise long-term local control of extremity STS despite full further oncological management.
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References
Clark MA, Fisher C, Judson I, Thomas JM. Soft tissue sarcomas in adults. New Engl J Med. 2005;353(7):701–11.
Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14(3):859–68.
Yang JC, Chang AE, Baker AR, Sindelar AF, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197–203.
Sarcoma Meta-analysis Collaboration. Adjuvant chemotherapy for localised resectable soft tissue sarcoma of adults: meta-analysis of individual data. Lancet. 1997;350(9092):1647–54.
Rosenberg, SA, Tepper J, Glatstein E, Costa J, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196(3):305–15.
Johansen R, Nielsen OS, Keller J. Functional outcome in sarcomas treated with limb-salvage surgery or amputation. Sarcoma. 1998;2(1):19–23.
Goodlad JR, Fletcher CDM, Smith MA. Surgical resection of primary soft-tissue sarcoma: incidence of residual tumour in 95 patients needing re-excision after local resection. J Joint Bone Surg. 1996;78(4):658–61.
Sondak VK, Chang AE. Enzinger and Weiss’s soft tissue tumors. Chapter 2: clinical evaluation and treatment of soft tissue tumors. 4th ed. Missouri: Mosby; 2002. p. 21–44.
Zagars GK, Ballo MT, Pisters PW, Pollock RE, Patel RS, Benjamin RS. Surgical margins and reresection in the management of patients with soft tissue sarcoma using conservative surgery and radiation therapy. Cancer. 2003;97(10):2544–53.
Enneking WF, Spanier SS, Malawer MM. The effect of the anatomic setting on the results of surgical procedures for soft parts sarcoma of the thigh. Cancer. 1981;47(5):1005–22.
Pitcher ME, Thomas JM. Functional compartmental resection for soft tissue sarcomas. Eur J Surg Oncol. 1994;20(4):441–5.
Robinson MH, Spruce L, EEles R, Fryatt I, et al. Limb function following conservation treatment of adult soft tissue sarcoma. Eur J Cancer. 1991;27(12):1567–74.
Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th ed. New York: Springer; 2002.
Coindre JM, Trojani M, Contesso G, David M, et al. Reproducibility of a histopathologic grading system for adult soft tissue sarcoma. Cancer. 1986;58(2):306–9.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.
Clasby R, Tilling K, Smith MA, Fletch CD. Variable management of soft tissue sarcoma: regional audit with implications for specialist care. Br J Surg. 1997;84(12):1692–6.
Lewis JJ, Leung D, Espat J, Woodruff JM, et al. Effect of reresection in extremity soft tissue sarcoma. Ann Surg. 2000;231(5):655–63.
Fiore M, Casali PG, Miceli R, Mariani L, Bertulli R, Lozza L, et al. Prognostic Effect of Re-Excision in Adult soft Tissue Sarcoma of the Extremity. Ann Surg Oncol. 2006;13(1):110–17.
Brennan MF. The enigma of local recurrence. Ann Surg Oncol. 1997;4(1):1–12.
Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007;356(23):2399–405.
Gronchi A, Lo Vullo S, Colombo C, Collini P, Stacchiotti S, Mariani L, Fiore M, Casali PG. Extremity soft tissue sarcoma in a series of patients treated at a single institution: the local control directly impacts survival. Ann Surg. 2010;251(3):506–11.
Hoeber, I, Spillane AJ, Fisher C, Thomas JM. Accuracy of biopsy techniques for limb and limb girdle soft tissue tumors. Ann Surg Oncol. 2001;8(1):80–7.
Strauss DC, Qureshi YA, Hayes AJ, Thway K, Fisher C, Thomas JM. The accuracy of core needle biopsy in the diagnosis of soft tissue tumors. J Surg Oncol. 2010;102(5):523–9.
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We acknowledge the NHS support to the NIHR Biomedical Research Centre at The Royal Marsden Hospital NHS Foundation Trust.
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Qureshi, Y.A., Huddy, J.R., Miller, J.D. et al. Unplanned Excision of Soft Tissue Sarcoma Results in Increased Rates of Local Recurrence Despite Full Further Oncological Treatment. Ann Surg Oncol 19, 871–877 (2012). https://doi.org/10.1245/s10434-011-1876-z
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DOI: https://doi.org/10.1245/s10434-011-1876-z