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Review
. 2023 Jun;30(6):3681-3689.
doi: 10.1245/s10434-023-13188-x. Epub 2023 Feb 17.

Unplanned Excision of Soft Tissue Sarcomas of the Extremities in a Low-to-Middle-Income Country

Edward H M Wang  1 , Karla Teresa S Araneta  2 , Czar Louie L Gaston  1 , Donnel Alexis T Rubio  1 , Ariel M Vergel de Dios  3 , Johanna Patricia A Cañal  4 , Amy N Goleta-Dy  5 , Ana Patricia A Alcasabas  5 , Eugene G Odoño  3 , Jenny Maureen L Atun  3 , Gracieux Y Fernando  6 , Cesar Cipriano D Dimayuga  1 , Albert Jerome D Quintos  1
Affiliations
Review

Unplanned Excision of Soft Tissue Sarcomas of the Extremities in a Low-to-Middle-Income Country

Edward H M Wang et al. Ann Surg Oncol. 2023 Jun.

Abstract

Background: Outcomes of unplanned excisions of extremity soft tissue sarcomas (STSE) range from poor to even superior compared with planned excisions in developed countries. However, little is known regarding outcomes in low-to-middle-income countries. This study aimed to determine whether definitively treated STSE patients with a previous unplanned excision have poorer oncologic outcomes compared with those with planned excisions.

Patients and methods: Using the database of a single sarcoma practice, we reviewed 148 patients with STSE managed with definitive surgery-78 with previous unplanned excisions (UE) and 70 with planned excisions (PE).

Results: Median follow-up was 4.4 years. UE patients had more surgeries overall and plastic reconstructions (P < 0.001). On multivariate analysis, overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were not worse among UE patients compared with PE patients. Negative predictors for LRFS were high tumor grade (P = 0.031) and an R1 surgical margin (P < 0.001). High grade (P <0.001), local recurrence (P = 0.001), and planned excisions (P = 0.009) predicted poorer DMFS, while age over 65 years (P = 0.011) and distant metastasis predicted poorer OS (P < 0.001).

Conclusions: We recommend systematic re-excision for patients with unplanned excisions. Our study shows that STSE patients with UE, when subjected to re-excision with appropriate surgical margins, can achieve oncologic results similar to those for PE patients. However, there is an associated increased number of surgeries and plastic reconstruction for UE patients. This underscores the need, especially in a resource-limited setting, for education and collaborative policies to raise awareness about STSE among patients and physicians.

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Figures

Fig. 1
Fig. 1
Cox estimates of survival in patients surgically treated for STSE according to type of initial treatment. A Overall survival, B local recurrence-free survival, and C distant metastasis-free survival
See this image and copyright information in PMC

Comment in

References

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