Do unplanned resections in soft tissue sarcomas of the extremities have an adverse impact on the prognosis? Experience of a Latin-American sarcoma reference center
Melendez-Fernandez Ana P , García-Ortega Dorian Y , Caro-Sanchez Claudia H. , Villavicencio-Valencia Veronica , Martinez-Said Hector , Cuellar-Hubbe Mario
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引用次数: 0
Abstract
Background
Soft tissue sarcomas (STS) are rare, heterogeneous neoplasms often not optimally managed by teams without sarcoma expertise. Between 40 % and 50 % of primary resections for extremity sarcomas occur without prior biopsy, resulting in inadequate excisions, termed “unplanned resections” or “whoops surgery.”
Objective
To determine the rate of unplanned resections in extremity STS referred to a high-volume sarcoma center and evaluate their impact on oncological outcomes.
Methods
A retrospective study of 680 extremity STS patients referred between 2005 and 2020. Of these, 239 (35 %) had unplanned resections. We analyzed the impact of unplanned resections on recurrence, disease-free survival (DFS), and overall survival (OS) after re-excision.
Results
Among the 239 patients with unplanned resections, 52 % were male, the median age was 46, and the most common histologies were liposarcoma (24 %) and synovial sarcoma (20 %). The median tumor size was 9 cm. Re-excisions achieved R0 margins of 88.6 %. Recurrence occurred in 26.3 % of cases and progression in 12.9 %, with an overall recurrence or progression rate of 39.2 %. The median DFS was 151 months for R0 resections, compared to 57.1–61.8 months for R1/R2 resections. The median OS was 140 months for R0 resections versus 50.8–52.3 months for R1/R2 resections.
Conclusions
Unplanned resections by non-specialized surgeons significantly reduce DFS and OS. Nonetheless, re-excision with negative margins (R0) provides oncological outcomes comparable to those reported in planned surgeries, emphasizing the importance of timely referral to specialized sarcoma centers.
期刊介绍:
Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.