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Blank A, Fice MP. Challenges in the Management of Complex Soft-Tissue Sarcoma Clinical Scenarios. J Am Acad Orthop Surg 2024; 32:e115-e124. [PMID: 37852242 DOI: 10.5435/jaaos-d-22-00865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/06/2023] [Indexed: 10/20/2023] Open
Abstract
With nearly 15,000 new cases of soft-tissue sarcoma (STS) in the United States each year, early diagnosis and therapeutic management is imperative for successful patient outcomes. Primary STS is conventionally treated with a combination of wide-margin resection, neoadjuvant or adjuvant radiation therapy, and, in specific cases, adjuvant chemotherapy. However, in situations of complex disease presentation, guidelines for treatment are less clearly outlined. Limited metastatic disease, local recurrence, fungating STSs, and unplanned or incomplete resections of STSs present unique challenges for the multidisciplinary care team. The management of complex STS clinical scenarios usually involves limb-salvage resection or amputation as well as some combination of radiation therapy and/or ablative interventional radiology techniques. As a result, a multidisciplinary team approach is essential for treating patients in these challenging scenarios, with a recent focus on the integration of plastic and reconstructive surgery into the treatment algorithm.
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Affiliation(s)
- Alan Blank
- From the Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL
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Larios F, Gonzalez MR, Ruiz-Arellanos K, Aquilino E Silva G, Pretell-Mazzini J. Is Unplanned Excision of Soft Tissue Sarcomas Associated with Worse Oncological Outcomes?-A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:443. [PMID: 38275885 PMCID: PMC10814439 DOI: 10.3390/cancers16020443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Soft tissue sarcomas are a group of rare neoplasms which can be mistaken for benign masses and be excised in a non-oncologic fashion (unplanned excision). Whether unplanned excision (UE) is associated with worse outcomes is highly debated due to conflicting evidence. METHODS We performed a systematic review and meta-analysis following PRISMA guidelines. Main outcomes analyzed were five-year overall survival (OS), five-year local recurrence-free survival (LRFS), amputation rate and plastic reconstruction surgery rate. Risk ratios were used to compare outcomes between patients treated with planned and unplanned excision. RESULTS We included 16,946 patients with STS, 6017 (35.5%) with UE. UE was associated with worse five-year LRFS (RR 1.35, p = 0.019). Residual tumor on the tumor bed was associated with lower five-year LRFS (RR = 2.59, p < 0.001). Local recurrence was associated with worse five-year OS (RR = 1.82, p < 0.001). UE was not associated with a worse five-year OS (RR = 0.90, p = 0.16), higher amputation rate (RR = 0.77, p = 0.134), or a worse plastic reconstruction surgery rate (RR = 1.25, p = 0.244). CONCLUSIONS Unplanned excision of Soft Tissue Sarcomas and the presence of disease in tumor bed after one were associated with worse five-year LRFS. Tumor bed excision should remain the standard approach, with special consideration to the presence of residual disease.
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Affiliation(s)
- Felipe Larios
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; (F.L.); (K.R.-A.)
| | - Marcos R. Gonzalez
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Kim Ruiz-Arellanos
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; (F.L.); (K.R.-A.)
| | | | - Juan Pretell-Mazzini
- Miami Cancer Institute, Division of Orthopedic Oncology, Baptist Health System South Florida, Plantation, FL 33324, USA
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Novillo-Casal D, Mandía-Mancebo FJ, Jorge-Mora AA, González-García J, de Castro-Carrasco A. Unplanned excision of soft tissue sarcomas of the musculoskeletal system. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:18-25. [PMID: 36841328 DOI: 10.1016/j.recot.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/12/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. MATERIAL AND METHODS 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. RESULTS Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.
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Affiliation(s)
- D Novillo-Casal
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España.
| | - F J Mandía-Mancebo
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - A A Jorge-Mora
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - J González-García
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - A de Castro-Carrasco
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
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Novillo-Casal D, Mandía-Mancebo FJ, Jorge-Mora AA, González-García J, De Castro-Carrasco A. [Translated article] Unplanned excision of soft tissue sarcomas of the musculoskeletal system. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T18-T25. [PMID: 37981200 DOI: 10.1016/j.recot.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/20/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to identify patient characteristics, tumours, surgical treatment and final results. MATERIAL AND METHODS 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with Chi2 tests and a Cox multivariate regression model. RESULTS Unplanned excisions of SPBAL have taken place in 18% of the patients in our area, mainly in tumours of less than 5cm and located superficial to the fascia. 29.2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumour, as well as adherence to the referral guidelines to reference centres.
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Affiliation(s)
- D Novillo-Casal
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Spain.
| | - F J Mandía-Mancebo
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | - A A Jorge-Mora
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | - J González-García
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | - A De Castro-Carrasco
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
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Schärer M, Heesen P, Bode-Lesniewska B, Studer G, Fuchs B. Benchmarking Time-to-Treatment Initiation in Sarcoma Care Using Real-World-Time Data. Cancers (Basel) 2023; 15:5849. [PMID: 38136394 PMCID: PMC10741448 DOI: 10.3390/cancers15245849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Benchmarking is a fundamental tool for enhancing quality within a patient-centered healthcare framework. This study presents an analysis of time-to-treatment initiation (TTI) for sarcoma patients, utilizing a database encompassing 266 cases from the Swiss Sarcoma Network. Our findings indicate a median TTI of 30 days across the cohort, with bone sarcomas and deep soft tissue sarcomas demonstrating a shorter median TTI of 28 days, followed by superficial soft tissue sarcomas at 42 days. The data reveal that the use of real-world-time data (RWTD) may account for a longer TTI observed, as it offers more comprehensive capture of patient journeys, unlike conventional datasets. Notably, variability in TTI was observed between different treatment institutions, which underscores the need for standardized processes across centers. We advocate for a selective referral system to specialized centers to prevent capacity overload and ensure timely treatment initiation. Our analysis also identified significant delays in TTI for unplanned 'whoops'-resections, highlighting the importance of early specialist referral in optimizing treatment timelines. This study emphasizes the potential benefits of a streamlined, data-informed approach to sarcoma care. However, further research is required to establish the direct impact of integrated care models on TTI and patient outcomes in the context of sarcoma treatment.
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Affiliation(s)
- Markus Schärer
- Sarcoma Service, Department of Orthopaedics and Trauma, University Teaching Hospital LUKS, 6000 Lucerne, Switzerland;
- Health Sciences and Medical Faculty, University of Lucerne, 6001 Lucerne, Switzerland
- Sarcoma Service, Department of Orthopaedics and Trauma, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
| | - Philip Heesen
- Sarcoma Service, University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland;
| | | | - Gabriela Studer
- Health Sciences and Medical Faculty, University of Lucerne, 6001 Lucerne, Switzerland
| | - Bruno Fuchs
- Sarcoma Service, Department of Orthopaedics and Trauma, University Teaching Hospital LUKS, 6000 Lucerne, Switzerland;
- Health Sciences and Medical Faculty, University of Lucerne, 6001 Lucerne, Switzerland
- Sarcoma Service, University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland;
- Pathologie Institut Enge, University of Zurich, 8000 Zurich, Switzerland
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Mihara A, Iwanaga R, Muramatsu K, Ihara K, Sakai T. Oncological and functional outcomes of planned and unplanned excision of soft tissue sarcoma: A retrospective study. J Orthop Sci 2023; 28:867-873. [PMID: 35491297 DOI: 10.1016/j.jos.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/25/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In soft tissue sarcomas, the oncological and functional outcomes between planned excision and unplanned excision with additional wide resection remains controversial. The purpose of this study is to determine the impact of unplanned excision on oncological and functional outcomes. METHODS A retrospective single-center study was performed. Patients with soft tissue sarcoma surgically treated in 2005-2019 were included in this study. A total of 120 patients consisting of planned excision (PE) group (n = 88), and unplanned excision (UE) group (n = 32) were included. Overall-survival (OS), local recurrence-free survival (LRFS), metastasis-free survival (MFS), disease-free survival (DFS), incidence rate of reconstructive surgery and musculoskeletal tumor society (MSTS) score were assessed. Propensity score matching method was used in statistical analysis. RESULTS The 5-year survival rate of OS, LRFS, MFS, and DFS did not differ between the PE and UE groups, however, rates of reconstructive surgery were higher in the UE group (PE: 48% vs. UE: 84%, p < 0.001). These results did not differ (PE: 41% vs. UE: 82%, p = 0.012) after propensity score matching was performed to align the backgrounds with difference in tumor size and depth. For MSTS score, the total score and "pain" and "emotional acceptance" scores were higher in the PE group before propensity score matching. The "pain" and "emotional acceptance" scores were higher in the PE group after propensity score matching also. CONCLUSIONS Unplanned excision did not deteriorate oncological outcomes, however unplanned excision lead to unnecessary reconstructive surgery. Unplanned excision adversely affected patient-reported outcomes without worsening pure functional outcomes.
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Affiliation(s)
- Atsushi Mihara
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Ryuta Iwanaga
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Koichiro Ihara
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
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Acem I, van Praag VM, Mostert CQ, van der Wal RJ, Neijenhuis RM, Verhoef C, Grünhagen DJ, van de Sande MA. Noninvasive detection of soft tissue sarcoma using volatile organic compounds in exhaled breath: a pilot study. Future Oncol 2023; 19:697-704. [PMID: 37129048 DOI: 10.2217/fon-2022-1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Aim: The aim of this pilot study was to assess whether an electronic nose can detect patients with soft tissue sarcoma (STS) based on volatile organic compound profiles in exhaled breath. Patients & methods: In this cross-sectional pilot study, patients with primary STS and healthy controls, matched on sex and age, were included for breath analysis. Machine learning techniques were used to develop the best-fitting model. Results: Fifty-nine breath samples were collected (29 STS and 30 control) from March 2018 to March 2022. The final model yielded a c-statistic of 0.85 with a sensitivity of 83% and specificity of 60%. Conclusion: This study suggests that exhaled volatile organic compound analysis could serve as a noninvasive diagnostic biomarker for the detection of STS with a good performance.
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Affiliation(s)
- Ibtissam Acem
- Department of Surgical Oncology & Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, Rotterdam, 3015, GD, The Netherlands
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| | - Veroniek M van Praag
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| | - Cassidy Qb Mostert
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| | - Robert Jp van der Wal
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| | - Ralph Ml Neijenhuis
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology & Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, Rotterdam, 3015, GD, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology & Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, Rotterdam, 3015, GD, The Netherlands
| | - Michiel Aj van de Sande
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
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Nannini S, Penel N, Bompas E, Willaume T, Kurtz JE, Gantzer J. Shortening the Time Interval for the Referral of Patients With Soft Tissue Sarcoma to Expert Centers Using Mobile Health: Retrospective Study. JMIR Mhealth Uhealth 2022; 10:e40718. [PMID: 36350680 PMCID: PMC9685503 DOI: 10.2196/40718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/17/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND According to guidelines, all patients with sarcoma must be managed from initial diagnosis at expert sarcoma centers. However, in everyday practice, the time interval to an expert center visit can be long, which delays presentation to an expert multidisciplinary tumor board and increases the risk of inappropriate management, negatively affecting local tumor control and prognosis. The advent of mobile health offers an easy way to facilitate communication and cooperation between general health care providers (eg, general practitioners and radiologists) and sarcomas experts. We developed a mobile app (Sar'Connect) based on the algorithm designed by radiologists from the French Sarcoma Group. Through a small number of easy-to-answer questions, Sar'Connect provides personalized advice for the management of patients and contact information for the closest expert center. OBJECTIVE This retrospective study is the first to assess this mobile app's potential benefits in reducing the time interval for patient referral to an expert center according to the initial clinical characteristics of the soft tissue tumor. METHODS From May to December 2021, we extracted tumor mass data for 78 patients discussed by the multidisciplinary tumor boards at 3 centers of the French Sarcoma Group. We applied the Sar'Connect algorithm to these data and estimated the time interval between the first medical description of the soft tissue mass and the referral to expert center. We then compared this estimated time interval with the observed time interval. RESULTS We found that the use of Sar'Connect could potentially shorten the time interval to an expert center by approximately 7.5 months (P<.001). Moreover, for half (31/60, 52%) of the patients with a malignant soft tissue tumor, Sar'Connect could have avoided inappropriate management outside of the reference center. We did not identify a significant determinant for shortening the time interval for referral. CONCLUSIONS Overall, promoting the use of a simple mobile app is an innovative and straightforward means to potentially accelerate both the referral and management of patients with soft tissue sarcoma at expert centers.
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Affiliation(s)
- Simon Nannini
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute, Strasbourg, France
| | - Nicolas Penel
- Department of Medical Oncology, Center Oscar Lambret, Lille University, Lille, France
| | - Emmanuelle Bompas
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nancy, France
| | - Thibault Willaume
- Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute, Strasbourg, France
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute, Strasbourg, France
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Minimally Invasive Surgical Approach for Open Common Peroneal Nerve Neurolysis in the Setting of Previous Posterior Schwannoma Removal. Arthrosc Tech 2022; 11:e705-e710. [PMID: 35493036 PMCID: PMC9052142 DOI: 10.1016/j.eats.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/16/2021] [Indexed: 02/03/2023] Open
Abstract
The common peroneal nerve (CPN) runs laterally around the fibular neck and enters the peroneal tunnel, where it divides into the deep, superficial, and recurrent peroneal nerves. CPN entrapment is the most common neuropathy of the lower extremity and is vulnerable at the fibular neck because of its superficial location. Schwannomas are benign, encapsulated tumors of the nerve sheath that can occur sporadically or in cases of neurocutaneous conditions, such neurofibromatosis type 2. In cases with compressive neuropathy resulting in significant or progressive motor loss, decompression and neurolysis should be attempted. We present a technical note for the treatment of CPN compressive neuropathy in the setting of a previous ipsilateral schwannoma removal with a minimally invasive surgical approach and neurolysis of the CPN at the fibular neck.
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Mosku N, Heesen P, Studer G, Bode B, Spataro V, Klass ND, Kern L, Scaglioni MF, Fuchs B. Biopsy Ratio of Suspected to Confirmed Sarcoma Diagnosis. Cancers (Basel) 2022; 14:cancers14071632. [PMID: 35406402 PMCID: PMC8996854 DOI: 10.3390/cancers14071632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/04/2022] [Accepted: 03/18/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Determining the biology of mesenchymal tumor, imaging alone is usually not enough, and the final diagnosis is established through tissue analysis If the indication to perform a biopsy is not established frequently enough, an undesired unplanned resection of a sarcoma may result, and conversely, a patient’s discomfort as well as costs may increase. In here, using a real-world data registry of quality, we included the absolute number of a consecutive series of patients, to determine the prevalence of biopsies and its related diagnosis, to establish a reference, which may allow for the definition of a quality indicator for the work-up within a multidisciplinary team. Abstract The ratio of malignancy in suspicious soft tissue and bone neoplasms (RMST) has not been often addressed in the literature. However, this value is important to understand whether biopsies are performed too often, or not often enough, and may therefore serve as a quality indicator of work-up for a multidisciplinary team (MDT). A prerequisite for the RMST of an MDT is the assessment of absolute real-world data to avoid bias and to allow comparison among other MDTs. Analyzing 950 consecutive biopsies for sarcoma-suspected lesions over a 3.2-year period, 55% sarcomas were confirmed; 28% turned out to be benign mesenchymal tumors, and 17% non-mesenchymal tumors, respectively. Of these, 3.5% were metastases from other solid malignancies, 1.5% hematologic tumors and 13% sarcoma simulators, which most often were degenerative or inflammatory processes. The RMST for biopsied lipomatous lesions was 39%. The ratio of unplanned resections was 10% in this series. Reorganizing sarcoma work-up into integrating practice units (IPU) allows the assessment of real-world data with absolute values over the geography, thereby enabling the definition of quality indicators and addressing cost efficiency aspects of sarcoma care.
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Affiliation(s)
- Nasian Mosku
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Philip Heesen
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Gabriela Studer
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Beata Bode
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Vito Spataro
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Natalie D. Klass
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Lars Kern
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Mario F. Scaglioni
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Bruno Fuchs
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
- Correspondence: ; Tel.: +41-41-229-50-00
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11
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Morinaga S, Miwa S, Yamamoto N, Hayashi K, Takeuchi A, Igarashi K, Tada K, Langit MB, Yonezawa H, Araki Y, Asano Y, Tsuchiya H. Clinical characteristics of patients with undergoing unplanned excisions of malignant soft tissue tumors. J Orthop Surg (Hong Kong) 2022; 29:23094990211057597. [PMID: 34893007 DOI: 10.1177/23094990211057597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Malignant soft tissue tumors are rare tumors representing <1% of all malignancies. As these tumors are rare, it is not uncommon that malignant soft tissue tumor excision is performed without the required preoperative imaging, staging, or wide resection margins for sarcomas. The purpose of this study was to investigate the characteristics of patients with undergoing unplanned excisions. Risk factors for tumor recurrence and mortality in patients treated with unplanned excisions were also analyzed. METHODS Forty-nine patients who underwent unplanned excision at other hospitals and additional wide excision at our hospital between January 2002 and December 2018 were identified. Among them, 42 patients with follow-up for more than 1 year were included in this retrospective study. The relationships between sex, age, tumor depth, histological grade, location, size, surgical margin at additional wide excision, residual tumor, reconstruction, kind of hospital where the primary excision was done (sarcoma vs non-sarcoma center), preoperative examination, chemotherapy, radiation therapy, and oncological outcomes were statistically analyzed. RESULTS Mean patient age was 57.3 years (15-85 years) and the mean observation period was 72.5 months (14-181 months). This analysis showed 53.8% tumors that underwent unplanned excisions were small (<5 cm) and 70.7% tumors were superficial. Multivariate analysis revealed that a positive margin during additional wide excision was significantly associated with a lower 5-year LRFS (p < 0.01). CONCLUSION Most of the tumors underwent unplanned excisions were small (<5 cm) and superficial. Surgeons should be aware that a positive margin during additional wide excision is an independent risk factor for local recurrence.
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Affiliation(s)
- Sei Morinaga
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Shinji Miwa
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Norio Yamamoto
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Akihiko Takeuchi
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Kentaro Igarashi
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Kaoru Tada
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Mickhael B Langit
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.,Department of Orthopedic Surgery, Philippine Orthopedic Center, Manilla, Philippines
| | - Hirotaka Yonezawa
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Yoshihiro Araki
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Yohei Asano
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
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12
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Tirotta F, Sayyed R, Jones RL, Hayes AJ. Risk factors for the development of local recurrence in extremity soft-tissue sarcoma. Expert Rev Anticancer Ther 2021; 22:83-95. [PMID: 34822313 DOI: 10.1080/14737140.2022.2011723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Local recurrence (LR) is one of the main pitfalls in surgery for extremities soft tissue sarcoma (eSTS). Achieving clear histopathological margins is the most important factor to reduce the risk of LR, but the ability to do so depends on not only surgical technique but also the interplay between tumor biology, anatomical location and surgical approach. The balance between postoperative morbidity and oncological benefits in reducing the risk of LR needs to be considered. AREAS COVERED This review will cover which etiological factors for the development of eSTS lead to an increased risk of LR and discuss histological subtypes that have a high risk of LR and which surgical and neoadjuvant therapeutic strategies can minimize the risk of LR. EXPERT OPINION The traditional view that surgical radicality always results in low rates of LR, while marginality alone always leads to high rates of relapse, is outdated. In the modern era of surgical oncology, limb salvage and high-level function after resectional surgery are the key surgical goals. The best results are achieved by combining effective neoadjuvant treatments with planned bespoke oncological operations that consider the biological and anatomical factors of each individual sarcoma.
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Affiliation(s)
- Fabio Tirotta
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Raza Sayyed
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Andrew J Hayes
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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13
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Nakamura T, Kawai A, Hagi T, Asanuma K, Sudo A. A comparison of clinical outcomes between additional excision after unplanned and planned excisions in patients with soft-tissue sarcoma of the limb : a propensity matching cohort study. Bone Joint J 2021; 103-B:1809-1814. [PMID: 34847719 DOI: 10.1302/0301-620x.103b12.bjj-2021-0037.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS Patients with soft-tissue sarcoma (STS) who undergo unplanned excision (UE) are reported to have worse outcomes than those who undergo planned excision (PE). However, others have reported that patients who undergo UE may have similar or improved outcomes. These discrepancies are likely to be due to differences in characteristics between the two groups of patients. The aim of the study is to compare patients who underwent UE and PE using propensity score matching, by analyzing data from the Japanese Bone and Soft Tissue Tumor (BSTT) registry. METHODS Data from 2006 to 2016 was obtained from the BSTT registry. Only patients with STS of the limb were included in the study. Patients with distant metastasis at the initial presentation and patients with dermatofibrosarcoma protuberans and well-differentiated liposarcoma were excluded from the study. RESULTS A total of 4,483 patients with STS of the limb were identified before propensity score matching. There were 355 patients who underwent UE and 4,128 patients who underwent PE. The five-year disease-specific survival (DSS) rate was significantly better in the patients who received additional excision after UE than in those who underwent PE. There was no significant difference in local recurrence-free survival (LRFS) between the two groups. After propensity score matching, a new cohort of 355 patients was created for both PE and UE groups, in which baseline covariates were appropriately balanced. Reconstruction after tumour excision was frequently performed in patients who underwent additional excision after UE. There were no significant differences in DSS and LRFS between the patients who underwent PE and those who had an additional excision after UE. CONCLUSION Using propensity score matching, patients with STS of the limb who underwent additional excision after UE did not experience higher mortality and local failure than those who underwent PE. Reconstruction may be necessary when additional excision is performed. Cite this article: Bone Joint J 2021;103-B(12):1809-1814.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomohito Hagi
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
| | - Kunihiro Asanuma
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
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14
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Melis AS, Vos M, Schuurman MS, van Dalen T, van Houdt WJ, van der Hage JA, Schrage YM, Been LB, Bonenkamp JB, Bemelmans MHA, Grünhagen DJ, Verhoef C, Ho VKY. Incidence of unplanned excisions of soft tissue sarcomas in the Netherlands: A population-based study. Eur J Surg Oncol 2021; 48:994-1000. [PMID: 34848102 DOI: 10.1016/j.ejso.2021.11.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Timely recognition of soft tissue sarcomas (STS) remains challenging, potentially leading to unplanned excisions (also known as 'whoops procedures'). This population-based study charted the occurrence of unplanned excisions and identified associated patient, tumour, and treatment-related characteristics. Furthermore, it presents an overview of the outcomes and clinical management following an unplanned excision. METHODS From the Netherlands Cancer Registry (NCR) database, information was obtained on 2187 adult patients diagnosed with STS in 2016-2019 who underwent surgery. Tumours located in the mediastinum, heart or retroperitoneum were excluded, as well as incidental findings. Differences between patients with planned and unplanned excisions were assessed with chi-square tests and a multivariable logistic regression model. RESULTS Overall, unplanned excisions comprise 18.2% of all first operations for STS, with a quarter of them occurring outside a hospital. Within hospitals, the unplanned excision rate was 14.4%. Unplanned excisions were more often performed on younger patients, and tumours unsuspected of being STS prior to surgery were generally smaller (≤5 cm) and superficially located. Preoperative imaging was omitted more frequently in these cases. An unplanned excision more often resulted in positive margins, requiring re-excision. Patients who had an unplanned excision outside of a sarcoma centre were more often discussed at or referred to a sarcoma centre, particularly in case of residual tumour. DISCUSSION Potential improvement in preventing unplanned excisions may be achieved by better compliance to preoperative imaging and referral guidelines, and stimulating continuous awareness of STS among general surgeons, general practitioners and private practices.
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Affiliation(s)
- Annemarie S Melis
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Melissa Vos
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Melinda S Schuurman
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Thijs van Dalen
- Department of Surgical Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jos A van der Hage
- Department of Surgical Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Yvonne M Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Lukas B Been
- Department of Surgical Oncology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Johannes B Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marc H A Bemelmans
- Department of Surgical Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Vincent K Y Ho
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
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15
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Danieli M, Barretta F, Fiore M, Radaelli S, Sangalli C, Barisella M, Stacchiotti S, Palassini E, Miceli R, Callegaro D, Casali PG, Gronchi A. Unplanned Excision of Extremity and Trunk Wall Soft Tissue Sarcoma: To Re-resect or Not to Re-resect? Ann Surg Oncol 2021; 28:4706-4717. [PMID: 33511543 DOI: 10.1245/s10434-020-09564-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The need for systematic reexcision in patients who underwent unplanned excision (UE) for extremity and superficial trunk soft tissue sarcoma (ESTSTS) has been questioned. We investigated the outcome of patients who underwent reexcision for ESTSTS compared with primarily resected at our institution and the prognostic impact of microscopic residual disease (MR) in the reexcision specimen. METHODS Primary ESTSTS patients surgically treated at our institution between 1997 and 2017 were divided in three groups: primarily resected (A), reexcised after macroscopically complete UE (B), and incomplete UE (C). Weighted overall survival (OS), crude cumulative incidence of local relapse (CCI-LR), and distant metastasis (CCI-DM) were calculated and compared. In group B, multivariable models were performed to assess factors associated with the outcomes. RESULTS A total of 1962 patients were identified: 1076, 697 and 189 in groups A, B, and C, respectively. Overall median follow-up was 85 months. Seven-year weighted-OS was 73.8%, 84.1%, and 80.7% (p < 0.001) for groups A, B, and C respectively. Seven-year CCI-LR and DM were 5.0% and 25.3%, 12.1% and 15.8%, and 13.6% and 29.4% (both p < 0.001) for groups A, B, and C, respectively. At multivariable analysis, the presence MR was associated with LR (p < 0.001) but not with OS nor CCI-DM. CONCLUSIONS UE and the presence of MR at pathology in reexcision specimen are associated to a higher risk of LR but not to a higher risk of DM or lower OS. After macroscopic complete UE, postponing reexcision until a LR occurs may be considered on an individualized basis.
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Affiliation(s)
- Maria Danieli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Radaelli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Sangalli
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Barisella
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Palassini
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Giovanni Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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16
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Liang Y, Guo TH, Xu BS, Hong DC, Qiu HB, Zhou ZW, Zhang X. The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis. Front Oncol 2021; 10:617590. [PMID: 33552992 PMCID: PMC7862753 DOI: 10.3389/fonc.2020.617590] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/18/2020] [Indexed: 11/27/2022] Open
Abstract
Background Unplanned excision (UPE) of soft tissue sarcoma (STS) is often chosen in the early phase by general physicians without any radiological evaluation. Purpose The present study aimed to evaluate the impact of UPE on the clinical outcomes of patients with STS of the trunk and extremity. Materials and Methods Patients with STS of the trunk and extremity who underwent R0 resection between 1998 and 2016 were included and divided into the UPE and planned excision (PE) groups. Propensity score matching (PSM) was used to control the selection bias. The endpoints were disease-specific survival (DSS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS). Results In total, 458 patients (277 males, 181 females; median age: 43 years) were included: 329 (71.8%) in the PE group and 129 (28.2%) in the UPE group. The follow-up time ranged from 7.1 to 313.78 months, with a median of 112.18 months. UPE patients were more likely to have a smaller or superficial lesion and were more frequently administered adjuvant therapy. After PSM, compared with the PE group, the UPE group had a longer LRFS (P=0.015), but there was no difference between the two groups regarding DSS and MFS. Residual disease was observed in 77.5% of the re-resected specimens in the UPE group and was a risk factor for DSS (P = 0.046) and MFS (P = 0.029) but was not associated with local recurrence (LR) (P=0.475) or LRFS (P=0.334). Moreover, we found no difference in DSS, LRFS or MFS according to the interval from UPE to definitive resection. Conclusion STS treated with UPE had distinct characteristics. Patients who undergo UPE followed by an additional wide R0 resection have similar oncological survival compared to patients who undergo an initial PE, although the high incidence of residual tumor in the UPE group leads to an unfavorable clinical course.
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Affiliation(s)
- Yao Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tian-Hui Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Melanoma and Sarcoma Medical Oncology Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bu-Shu Xu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Melanoma and Sarcoma Medical Oncology Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dong-Chun Hong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Melanoma and Sarcoma Medical Oncology Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hai-Bo Qiu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhi-Wei Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xing Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Melanoma and Sarcoma Medical Oncology Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
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17
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Erol B, Baysal Ö. Does Unplanned Soft Tissue Sarcoma Surgery Have a Negative Effect on Prognosis? J INVEST SURG 2020; 35:38-43. [PMID: 32862737 DOI: 10.1080/08941939.2020.1813852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND We aimed to compare the oncological outcomes of patients who underwent re-excision following unplanned surgery and those who underwent planned surgery. METHODS Patients who were referred to our hospital after a mass was inappropriately resected and reported to have a malignant pathology with a positive surgical margin, as well as patients diagnosed with malignant soft tissue tumors, and operated on following a multidisciplinary assessment and staging between 2012 and 2018. All patients were followed up at least 6 months. RESULTS Our study included a total of 125 patients. Forty percent (n = 50) underwent unplanned excision and sixty percent (n = 75) underwent planned excision.There was no statistically significant difference in the survival curves between the two groups (p = 0.248). Tumor size was larger, and the rate of deep-localized tumors was higher in patients undergoing planned surgery than in the unplanned surgery group (p = 0.001). The rate of tumors localized in the upper extremities was significantly higher in the unplanned surgery group than in the planned surgery (p = 0.033). MRI examinations could detect residual tumors with an accuracy of 80%. Age (>48 years), tumor size (>8 cm), tumor grade (grade 3), and distant organ metastasis at follow-up, which were among risk factors found to have a significant effect on mortality. CONCLUSION Patients undergoing re-excision after an inappropriate resection and undergoing planned resection had a similar prognosis. Superficial, upper extremity-localized, and relatively small-size tumors are more prone to inadequate surgical resection. MRI can be used to detect residual tumors at a high rate in patients who have undergone unplanned surgery. Distant organ metastasis is the most important factor affecting survival.
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Affiliation(s)
- Bülent Erol
- Department of Orthopaedic and Traumatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Özgür Baysal
- Department of Orthopaedic and Traumatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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18
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Gamboa AC, Gronchi A, Cardona K. Soft-tissue sarcoma in adults: An update on the current state of histiotype-specific management in an era of personalized medicine. CA Cancer J Clin 2020; 70:200-229. [PMID: 32275330 DOI: 10.3322/caac.21605] [Citation(s) in RCA: 253] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
Soft-tissue sarcomas (STS) are rare tumors that account for 1% of all adult malignancies, with over 100 different histologic subtypes occurring predominately in the trunk, extremity, and retroperitoneum. This low incidence is further complicated by their variable presentation, behavior, and long-term outcomes, which emphasize the importance of centralized care in specialized centers with a multidisciplinary team approach. In the last decade, there has been an effort to improve the quality of care for patients with STS based on anatomic site and histology, and multiple ongoing clinical trials are focusing on tailoring therapy to histologic subtype. This report summarizes the latest evidence guiding the histiotype-specific management of extremity/truncal and retroperitoneal STS with regard to surgery, radiation, and chemotherapy.
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Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Georgia
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer Institute, Emory University Hospital Midtown, Atlanta, Georgia
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Tiwari A. Management of bone and soft-tissue sarcomas: From state of practice to state of art. CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_107_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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