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Generaal JD, Jansen MR, van Leeuwen GL, van Ginkel RJ, Been LB, van Leeuwen BL. Twenty-five years of experience with patient-reported outcome measures in soft-tissue sarcoma patients: a systematic review. Qual Life Res 2024:10.1007/s11136-024-03755-4. [PMID: 39259455 DOI: 10.1007/s11136-024-03755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE As the importance of the patient's perspective on treatment outcome is becoming increasingly clear, the availability of patient-reported outcome measures (PROMs) has grown accordingly. There remains insufficient information regarding the quality of PROMs in patients with soft-tissue sarcomas (STSs). The objectives of this systematic review were (1) to identify all PROMs used in STS patients and (2) to critically appraise the methodological quality of these PROMs. METHODS Literature searches were performed in MEDLINE and Embase on April 22, 2024. PROMs were identified by including all studies that evaluate (an aspect of) health-related quality of life in STS patients by using a PROM. Second, studies that assessed measurement properties of the PROMs utilized in STS patients were included. Quality of PROMs was evaluated by performing a COSMIN analysis. RESULTS In 59 studies, 39 PROMs were identified, with the Toronto Extremity Salvage Score (TESS) being the most frequently utilized. Three studies evaluated methodological quality of PROMs in the STS population. Measurement properties of the TESS, Quick Disability of the Arm, Shoulder and Hand (QuickDASH) and European Organization for Research and Treatment for Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) were reported. None of the PROMs utilized in the STS population can be recommended for use based on the current evidence and COSMIN analysis. CONCLUSION To ensure collection of reliable outcomes, PROMs require methodological evaluation prior to utilization in the STS population. Research should prioritize on determining relevant content and subsequently selecting the most suitable PROM for assessment.
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Affiliation(s)
- Jasmijn D Generaal
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Marnix R Jansen
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Goudje L van Leeuwen
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Robert J van Ginkel
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Lukas B Been
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Morii T, Sato K, Ogura K, Kawai A. Incidence and risk of infection in malignant soft tissue tumor resection: Data from the nationwide soft tissue tumor registry. J Orthop Sci 2024; 29:1300-1305. [PMID: 37599134 DOI: 10.1016/j.jos.2023.08.002] [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: 05/17/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Postoperative infection is a devastating complication in limb salvage surgery for malignant soft tissue tumors. The low absolute case numbers of these rare cancers represent a bottleneck for data collection and analysis. The administration of nationwide registry data is a practical option for the accumulation of cases. METHODS Data on malignant soft tissue tumor resection were extracted from the Bone and Soft Tissue Tumor Registry in Japan. The incidence of postoperative infection and its risk factors were analyzed. RESULTS A total of 14,460 cases were included. The incidence of infection was 2.6%. Significant risks for infection were male sex, lower extremity or trunk location, tumor diameter of over 10 cm, trans-compartmental invasion, high grade, autologous bone graft, myocutaneous flap, vascular reconstruction, reconstruction by prosthesis, postoperative radiotherapy, and delayed wound healing. CONCLUSIONS The incidence was lower than those in the previous studies, perhaps because of less frequent radiotherapy application. Some of the significant risk factors represented local invasiveness of the tumor, suggesting the importance of the preservation of soft tissue for infection prevention. The administration of nationwide registry data was informative for the analysis of infection in malignant soft tissue tumor resection.
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Affiliation(s)
- Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Kenji Sato
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Koichi Ogura
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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3
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Lazarides AL, Burke ZDC, Gundavda MK, Clever DC, Griffin AM, Tsoi K, Ferguson PC, Wunder JS. Mapping the Course of Recovery Following Limb-Salvage Surgery for Soft-Tissue Sarcoma of the Extremities. J Bone Joint Surg Am 2024:00004623-990000000-01183. [PMID: 39172902 DOI: 10.2106/jbjs.23.01007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND Despite the goal of an acceptable functional result, the surgical treatment of soft-tissue sarcoma can portend a prolonged course of recovery. More comprehensive data on the expected course of recovery following extremity sarcoma surgery are needed to help to inform physicians and patients. The purpose of the present study was to describe the typical course of functional recovery following limb-salvage resection of a soft-tissue sarcoma and to identify factors associated with a delayed postoperative course of recovery. METHODS A retrospective review of a prospectively maintained institutional database was performed for all patients undergoing surgical treatment with limb salvage of a soft-tissue sarcoma of the extremities or pelvis with at least 1 year of follow-up after the definitive surgical procedure. All patients were required to have preoperative functional outcomes recorded for either the Toronto Extremity Salvage Score (TESS) or the Musculoskeletal Tumor Society (MSTS) score and functional outcome measures at 1 year postoperatively. The primary outcome measures were time to recovery and maximal functional improvement. RESULTS In this study, 916 patients met inclusion criteria following surgical resection of a soft-tissue sarcoma of the extremities. The median follow-up was 74 months. Patients typically achieved a return to their baseline preoperative level of function for all functional outcome measures by 1 to 2 years and achieved maximal functional recovery by 2 years postoperatively. Older age, female sex, deep tumor location, larger tumor size, pelvic location, osseous resection, motor nerve resection, free and/or rotational soft-tissue coverage, and postoperative complications were independently associated with worse TESS and/or MSTS scores (p ≤ 0.05). Tumor recurrence was associated with worse functional outcomes scores. An analysis was performed to determine which patients had a prolonged course of recovery (i.e., were considered to still be recovering). Older age, female sex, larger tumor size, osseous resection, and motor nerve resection were associated with a delayed course of recovery (p ≤ 0.04). Complications and tumor recurrence were associated with delayed functional recovery across all domains. CONCLUSIONS Most patients will achieve maximal recovery by 2 to 3 years following surgical resection for soft-tissue sarcoma of the extremities. Older age, female sex, larger tumor size, osseous resection, motor nerve resection, postoperative complications, and tumor recurrence portend poorer functional outcomes and a delayed course of recovery. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander L Lazarides
- Sarcoma Department, Moffitt Cancer Center, Tampa, Florida
- University of Toronto Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Zachary D C Burke
- University of Toronto Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Orthopaedic Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Manit K Gundavda
- University of Toronto Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Oncology, Centre for Bone and Joint Cancer, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - David C Clever
- University of Toronto Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anthony M Griffin
- University of Toronto Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kim Tsoi
- University of Toronto Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Ferguson
- University of Toronto Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jay S Wunder
- University of Toronto Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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N Hoang M, Nyqvist E, Hesla AC, Tsagkozis P, Löfgren J. Wound healing after surgery for soft tissue sarcomas, and the effect of primary plastic reconstruction - A retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108348. [PMID: 38677000 DOI: 10.1016/j.ejso.2024.108348] [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] [Received: 02/11/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Immediate vascularized reconstruction after sarcoma resection may reduce wound complications common in primary closure, but previous research is conflicting. The present study analysed wound complication rates and compared wound-related outcomes among immediate vascularized reconstruction with primary closure. MATERIALS AND METHODS Patient- and tumour characteristics were collected from patients who received primary surgery with curative intent between 2010 and 2020 at the Stockholm Sarcoma Centre. Clinical outcomes were sought in free text in medical records. The primary outcome measures were early (<30 days) wound complications. Secondary outcome measures included late (30-day to 2-year) wound complications, time to wound healing, 30-day postoperative complications according to Clavien Dindo, and health care consumption. RESULTS A total of 482 patients were included, of whom 69 had immediate vascularized reconstruction. Comparison of early complications for reconstructive surgery with primary closure revealed a significantly higher complication rate for the first group (59.4 % vs 29.8 %, p < 0.01). The groups had comparable health care consumption the first and second postoperative years. In-depth analyses identified BMI >25, smoking and high-grade lesions as factors with adverse effects on wound healing. CONCLUSIONS Sarcoma patients experience high rates of wound complications and consume considerable health care resources. Reconstructed individuals were more susceptible to such complications than were subjects with primary closure.
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Affiliation(s)
- Madeleine N Hoang
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
| | - Emmy Nyqvist
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Asle Charles Hesla
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Panagiotis Tsagkozis
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
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LaValley MN, Dugue D, Diaddigo SE, Kuonqui KG, Tyler WK, Bogue JT. A Systematic Review of the Orthoplastic Approach in Adult Lower Extremity Soft Tissue Sarcoma Flap Reconstruction. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00001. [PMID: 38421606 PMCID: PMC10906598 DOI: 10.5435/jaaosglobal-d-23-00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND The orthoplastic approach to patient care has changed the way patients with a wide variety of lower extremity pathology are treated. Through a systematic review, we aim to analyze outcomes in adult patients with lower extremity soft tissue sarcomas who undergo an orthoplastic flap management approach to their care. METHODS A systematic review of adult lower extremity soft tissue sarcoma excision with plastic surgery flap reconstruction was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines searching the Pubmed, Embase, and Web of Science databases from inception to April 2023. RESULTS After removal of duplicates, title and abstract screening, and full-text review, 26 articles were accepted for inclusion. The total mean follow-up duration was 32.0 ± 24.3 months. Reconstruction used microvascular free flaps in 65.5% (487/743), while 34.5% (256/743) were local flaps. 85.8% (307/358) of patients ambulated postoperatively. Revision surgery was required in 21% of patients during their respective follow-up periods. The limb salvage rate was 93.4% (958/1,026). Among pooled surgical outcomes, 22.2% (225/1,012) of patients experienced a perioperative complication. DISCUSSION Our study demonstrates that although complication rates in lower extremity soft tissue sarcoma reconstruction may be further optimized, a multidisciplinary flap reconstructive approach provides high rates of limb salvage and functional postoperative ambulation.
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Affiliation(s)
- Myles N. LaValley
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - David Dugue
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Sarah E. Diaddigo
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Kevin G. Kuonqui
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Wakenda K. Tyler
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Jarrod T. Bogue
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
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6
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Cohen Z, Plotsker E, Graziano F, Cordeiro P, Disa J, Mehrara B, Fabbri N, Azoury SC, Shahzad F. The evolution of pediatric soft-tissue free flap reconstruction of the lower extremity after oncologic resection: A 30 year experience. Microsurgery 2024; 44:e31130. [PMID: 37877296 PMCID: PMC11296888 DOI: 10.1002/micr.31130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Limb salvage has become the standard of care for lower extremity tumors because of improvements in adjuvant treatments and reconstructive techniques. While there is literature assessing pediatric lower extremity free flap reconstruction in the setting of trauma, there is a paucity of literature that analyzes oncologic free flap reconstruction in this patient population. We report our long-term experience and evolution of care for lower extremity oncologic free flap reconstruction in pediatric patients. METHODS This is a retrospective case series of all patients ≤18 years of age who underwent oncologic soft-tissue microvascular reconstruction of the lower extremity, from 1992 to 2021. Data were collected for patient demographics, oncologic treatment, operative details, and post-operative outcomes. Functional outcomes were assessed by weight bearing status, ambulation, and participation in activities-of-daily-living (ADLs), and musculoskeletal tumor society (MSTS) scores. RESULTS Over the 30-year study period, inclusion criteria were met by 19 patients (11 males, 8 females) with a mean age of 13.8 years and a mean follow-up of 5.3 years. At last follow-up, 13 patients (68.5%) were alive. The most common pathology was osteogenic sarcoma (13 patients, 68.5%). Sites of reconstruction were the hip (n = 1), thigh (n = 5), knee (n = 4), leg (n = 7), and the foot (n = 2). The most commonly used flaps were latissimus dorsi (n = 8), gracilis (n = 4), and anterolateral thigh ± vastus (n = 4). Postoperative complications occurred in nine patients (43%). Overall flap success rate was 95%. At latest follow-up, ambulation without assistive device was obtained in 11 patients (58%), full weight bearing was achieved by 13 patients (68.5%), and ADLs could be performed independently by 13 patients (68.5%). Mean MSTS score was 23.1/30. CONCLUSION Microvascular reconstruction for oncological lower extremity defects in the pediatric population has high limb salvage rates and good functional outcomes.
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Affiliation(s)
- Zack Cohen
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ethan Plotsker
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Francis Graziano
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter Cordeiro
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph Disa
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Babak Mehrara
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicola Fabbri
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Saïd C Azoury
- Division of Plastic Surgery, Department of Surgery University of Pennsylvania
- Department of Orthopedic Surgery, University of Pennsylvania
| | - Farooq Shahzad
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
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7
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Rowell PD, Ferguson PC, Tsoi KM, Nevin JL, Novak R, Griffin AM, Wunder JS. Endoprosthetic reconstruction for lower extremity soft tissue sarcomas with bone involvement. J Surg Oncol 2023; 128:660-666. [PMID: 37144623 DOI: 10.1002/jso.27300] [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] [Received: 01/23/2023] [Revised: 03/24/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Bone resection and endoprosthetic reconstruction (EPR) in the setting of soft tissue sarcoma (STS) management is rare and incurs unique challenges. We aim to report on the surgical and oncological outcomes of this relatively previously undocumented cohort. METHODS This is a single-center retrospective review of prospectively collected data for patients who required EPRs following resection of STSs of the lower extremity. Following inclusion criteria, we assessed 29 cases of EPR for primary STS of the lower limb. RESULTS The mean age was 54 years (range 18-84). Of the 29 patients, there were 6 total femur, 11 proximal femur, 4 intercalary, and 8 distal femur EPRs. Fourteen of 29 patients (48%) underwent re-operations for surgical complications, with 9 relating to infection (31%). When a matched cohort analysis was performed comparing our cohort to STSs that did not necessitate EPR, a reduced rate of overall survival and metastasis-free survival was found in those requiring EPR. CONCLUSION This series identifies a high rate of complication from EPRs performed for STS. Patients should be cautioned about the high rate of infection, surgical complications, and lower overall survival in this setting.
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Affiliation(s)
- P D Rowell
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - P C Ferguson
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - K M Tsoi
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - J L Nevin
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - R Novak
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - A M Griffin
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - J S Wunder
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
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Wiffen J, Mah E. Determining functional outcomes after resection and reconstruction of primary soft tissue sarcoma in the lower extremity: A review of current subjective and objective measurement systems. J Surg Oncol 2023; 127:862-870. [PMID: 36683344 DOI: 10.1002/jso.27202] [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: 07/06/2022] [Revised: 11/27/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
The surgical management of soft-tissue sarcoma has evolved significantly over the last two decades due to the routine use of adjunct therapies, with an increased focus on postoperative functional outcome. The literature suffers from methodological inconsistency and use of low quality outcome measures to assess an already heterogeneous population. This article aims to review the most frequently used subjective and objective methods of functional outcome assessment and highlight the current benefits and limitations of these.
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Affiliation(s)
- James Wiffen
- St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Eldon Mah
- Department of Plastic & Reconstructive Surgery, St Vincent's Hospital, Melbourne, Australia
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Pedicled Functional Latissimus Flaps for Reconstruction of the Upper Extremity following Resection of Soft-Tissue Sarcomas. Curr Oncol 2023; 30:3138-3148. [PMID: 36975450 PMCID: PMC10047364 DOI: 10.3390/curroncol30030237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
(1) Background: Resection of soft-tissue sarcomas (STS) of the upper extremity can result in substantial functional impairment with limited options for functional reconstruction. Free functional latissimus flaps have been utilized to restore function of the thigh; however, there is limited data on the use of latissimus flaps for functional reconstruction in the upper extremity. As such, we sought to evaluate our institutional experience with these flaps. (2) Methods: We reviewed ten (seven male; three female; and a mean age of 63 years) patients undergoing soft-tissue sarcoma resection involving the triceps (n = 4), biceps (n = 4), and deltoid (n = 2) reconstructed with a pedicled functional latissimus flap. All surviving patients had at least 1 year of follow-up, with a mean follow-up of 5 years. (3) Results: The mean elbow range of motion and shoulder elevation were 105° and 150°. The mean Musculoskeletal Tumor Society score was 88%, and the muscle strength was four. Four patients had a recipient site wound complication. There were no flap losses. One patient sustained a radiation-associated humerus fracture 5 years postoperatively, treated nonoperatively. (4) Conclusions: Although early complications are high, pedicled functional latissimus flaps allow for wound coverage, potential space obliteration, and restoration of function in the upper extremity following resection of large soft tissue sarcomas.
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10
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Thalji SZ, Ethun CG, Tsai S, Gamblin TC, Clarke CN, Bedi M, King D, LoGiudice J, Poultsides G, Grignol VP, Tseng J, Votanopoulos K, Fields RC, Cardona K, Mogal H. Outcomes of plastic surgical reconstruction in extremity and truncal soft tissue sarcoma: Results from the US Sarcoma Collaborative. J Surg Oncol 2023; 127:550-559. [PMID: 36477427 DOI: 10.1002/jso.27169] [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: 11/19/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to define how utilization of plastic surgical reconstruction (PSR) affects perioperative outcomes, locoregional recurrence-free survival (LRRFS), and overall survival (OS) after radical resection of extremity and truncal soft tissue sarcoma (ETSTS). The secondary aim was to determine factors associated with PSR. METHODS Patients who underwent resection of ETSTS between 2000 and 2016 were identified from a multi-institutional database. PSR was defined as complex primary closure requiring a plastic surgeon, skin graft, or tissue-flap reconstruction. Outcomes included PSR utilization, postoperative complications, LRRFS, and OS. RESULTS Of 2750 distinct operations, 1060 (38.55%) involved PSR. Tissue-flaps (854, 80.57%) were most commonly utilized. PSR was associated with a higher proportion of R0 resections (83.38% vs. 74.42%, p < 0.001). Tissue-flap PSR was associated with local wound complications (odds ratio: 1.81, confidence interval: 1.21-2.72, p = 0.004). Neither PSR nor postoperative complications were independently associated with LRRFS or OS. High-grade tumors (1.60, 1.13-2.26, p = 0.008) and neoadjuvant radiation (1.66, 1.20-2.30, p = 0.002) were associated with the need for PSR. CONCLUSION Patients with ETSTS undergoing resection with PSR experienced acceptable rates of complications and a higher rate of negative margins, which were associated with improved LRRFS and OS. High tumor grade and neoadjuvant radiation were associated with requirement of PSR.
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Affiliation(s)
- Sam Z Thalji
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Cecilia G Ethun
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Susan Tsai
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - T Clark Gamblin
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Callisia N Clarke
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David King
- Department of Orthopedic Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John LoGiudice
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Valerie P Grignol
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Harveshp Mogal
- Department of Surgery, University of Washington, Seattle, Washington, USA
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11
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Hassan AM, Tesfaye EA, Rashiwala A, Roubaud MJ, Mericli AF. Functional Muscle Transfer after Oncologic Extremity Resection. J Reconstr Microsurg 2023; 39:195-208. [PMID: 35768008 DOI: 10.1055/a-1887-7530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Functional muscle transfer (FMT) can provide wound closure and restore adequate muscle function for patients with oncologic extremity defects. Herein we describe our institutional experience with FMT after oncological resection and provide a systematic review and meta-analysis of the available literature on this uncommon procedure. METHODS A single-institution retrospective review was performed, including all patients who received FMT after oncological resection from 2005 to 2021. For the systematic review and meta-analysis, PubMed, Cochrane, Medline, and Embase libraries were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; results were pooled, weighted by study size, and analyzed. RESULTS The meta-analysis consisted of seven studies with 70 patients overall, demonstrating a mean Medical Research Council (MRC) score of 3.78 (95% confidence interval: 2.97-4.56; p < 0.01). The systematic review included 28 studies with 103 patients. Receipt of adjuvant chemotherapy was associated with significantly lower mean MRC score (3.00 ± 1.35 vs. 3.90 ± 1.36; p = 0.019). Seventy-four percent of the patients underwent free FMT, with the most common donor muscle being the latissimus dorsi (55%). The flap loss rate was 0.8%. Neoadjuvant chemotherapy (p = 0.03), radiotherapy (p = 0.05), pedicled FMTs (p = 0.01), and a recipient femoral nerve (p = 0.02) were associated with significantly higher complication rates. The institutional retrospective review identified 13 patients who underwent FMT after oncological resection with a median follow-up time of 21 months (range: 6-74 months). The most common tumor necessitating FMT was undifferentiated pleomorphic sarcoma (77%), and the most common donor muscle was the latissimus dorsi (62%). A high body mass index was associated with prolonged neuromuscular recovery (R = 0.87, p = 0.002). CONCLUSION FMT after oncological resection may contribute to improved extremity function. Careful consideration of risk factors and preoperative planning is imperative for successful FMT outcomes.
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Affiliation(s)
- Abbas M Hassan
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eliora A Tesfaye
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Abhi Rashiwala
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Margaret J Roubaud
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexander F Mericli
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Novak R, Nevin JL, Rowell PD, Griffin A, Mazin S, Hofer SOP, O'Neill AC, Tsoi K, Ferguson PC, Wunder JS. A Size-Based Criteria for Flap Reconstruction After Thigh-Adductor, Soft-Tissue Sarcoma Resection. Ann Surg Oncol 2023; 30:3701-3711. [PMID: 36840861 DOI: 10.1245/s10434-023-13261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/01/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Resection of soft-tissue sarcomas from the adductor compartment is associated with significant complications. Free/pedicled flaps often are used for wound closure, but their effect on healing is unclear. We compared wound complications, oncologic, and functional outcomes for patients undergoing flap reconstruction or primary closure following resection of adductor sarcomas. METHODS A total of 177 patients underwent resection of an adductor sarcoma with primary closure (PrC) or free/pedicled flap reconstruction (FR). Patient, tumor, and treatment characteristics were compared, as well as wound complications, oncologic, and functional outcomes (TESS/MSTS87/MSTS93). To examine the relative benefit of flap reconstruction, number needed to treat (NNT) was calculated. RESULTS In total, 143 patients underwent PrC and 34 had FR, 68% of which were pedicled. There were few differences in demographic, tumor, or treatment characteristics. No significant difference was found in the rate of wound complications. Length of stay was significantly longer in FR (18 days vs. PrC 8 days; p < 0.01). Oncologic and functional outcomes were similar over 5 years follow-up. Uncomplicated wound healing occurred more often in FR compared with PrC for tumors with ≥15 cm (NNT = 8.4) or volumes ≥ 800 ml (NNT = 8.4). Tumors ≤ 336 ml do not benefit from a flap, whereas those > 600 ml are 1.5 times more likely to heal uneventfully after flap closure. CONCLUSIONS Although flap use prolonged hospitalization, it decreased wound healing complications for larger tumors, and in all sized tumors, it demonstrated similar functional and oncologic outcomes to primary closure. Our size-based treatment criteria can help to identify patients with large adductor sarcomas who could benefit from flap reconstruction. LEVEL OF EVIDENCE III (Retrospective cohort study).
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Affiliation(s)
- Rostislav Novak
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
| | - Jennifer L Nevin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Philip D Rowell
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Anthony Griffin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Sergey Mazin
- Department of Software Engineering, ORT Braude Academic College, Karmiel, Israel
| | - Stefan O P Hofer
- Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, University Health Network, Toronto, Canada
| | - Anne C O'Neill
- Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, University Health Network, Toronto, Canada
| | - Kim Tsoi
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, University Health Network, Toronto, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, University Health Network, Toronto, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, University Health Network, Toronto, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
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13
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Spierenburg G, Verspoor FGM, Wunder JS, Griffin AM, Ferguson PC, Houdek MT, King DM, Boyle R, Lor Randall R, Thorpe SW, Priester JI, Geiger EJ, van der Heijden L, Bernthal NM, Schreuder BHWB, Gelderblom H, van de Sande MAJ. One-Stage Synovectomies Result in Improved Short-Term Outcomes Compared to Two-Stage Synovectomies of Diffuse-Type Tenosynovial Giant Cell Tumor (D-TGCT) of the Knee: A Multicenter, Retrospective, Cohort Study. Cancers (Basel) 2023; 15:cancers15030941. [PMID: 36765897 PMCID: PMC9913566 DOI: 10.3390/cancers15030941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Diffuse-type tenosynovial giant cell tumors' (D-TGCTs) intra- and extra-articular expansion about the knee often necessitates an anterior and posterior surgical approach to facilitate an extensive synovectomy. There is no consensus on whether two-sided synovectomies should be performed in one or two stages. This retrospective study included 191 D-TGCT patients from nine sarcoma centers worldwide to compare the postoperative short-term outcomes between both treatments. Secondary outcomes were rates of radiological progression and subsequent treatments. Between 2000 and 2020, 117 patients underwent one-stage and 74 patients underwent two-stage synovectomies. The maximum range of motion achieved within one year postoperatively was similar (flexion 123-120°, p = 0.109; extension 0°, p = 0.093). Patients undergoing two-stage synovectomies stayed longer in the hospital (6 vs. 4 days, p < 0.0001). Complications occurred more often after two-stage synovectomies, although this was not statistically different (36% vs. 24%, p = 0.095). Patients treated with two-stage synovectomies exhibited more radiological progression and required subsequent treatments more often than patients treated with one-stage synovectomies (52% vs. 37%, p = 0.036) (54% vs. 34%, p = 0.007). In conclusion, D-TGCT of the knee requiring two-side synovectomies should be treated by one-stage synovectomies if feasible, since patients achieve a similar range of motion, do not have more complications, but stay for a shorter time in the hospital.
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Affiliation(s)
- Geert Spierenburg
- Department of Orthopedic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence: ; Tel.: +31-(0)71-5263161
| | - Floortje G. M. Verspoor
- Department of Orthopedic Surgery, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands
| | - Jay S. Wunder
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Anthony M. Griffin
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Peter C. Ferguson
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Matthew T. Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - David M. King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Richard Boyle
- Department of Orthopedic Surgery, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Robert Lor Randall
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Steven W. Thorpe
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Jacob I. Priester
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Erik J. Geiger
- Rothman Institute and Department of Orthopedic Surgery Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Nicholas M. Bernthal
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, CA 90404, USA
| | | | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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14
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Ramsey DC, Walker JR, Wetzel R, Gundle KR, Hayden JB, Doung YC. Is the Addition of Anaerobic Coverage to Perioperative Antibiotic Prophylaxis During Soft Tissue Sarcoma Resection Associated With a Reduction in the Proportion of Wound Complications? Clin Orthop Relat Res 2022; 480:2409-2417. [PMID: 35901448 PMCID: PMC10538887 DOI: 10.1097/corr.0000000000002308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/13/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Wound complications are common after resection of soft tissue sarcomas, with published infection rates ranging from 10% to 35%. Multiple studies have reported on the atypical flora comprising these infections, which are often polymicrobial and contain anaerobic bacteria, and recent studies have noted the high prevalence of anaerobic bacterial infections after soft tissue sarcoma resection [ 26, 35 ]. Based on this, our institution changed clinical practice to include an antibiotic with anaerobic coverage in addition to the standard first-generation cephalosporin for prophylaxis during soft tissue sarcoma resections. The current study was undertaken to evaluate whether this change was associated with a change in major wound complications, and if the change should therefore be adopted for future patients. QUESTIONS/PURPOSES (1) After controlling for potentially confounding variables, was the broadening of the prophylactic antibiotic spectrum to cover anaerobic bacteria associated with a lower odds of major wound complications after soft tissue sarcoma resection? (2) Was the broadening of the prophylactic antibiotic spectrum to cover anaerobic bacteria associated with a lower odds of surgical site infections with polymicrobial or anaerobic infections after soft tissue sarcoma resection? (3) What are the factors associated with major wound complications after soft tissue sarcoma resection? METHODS We retrospectively identified 623 patients who underwent soft tissue sarcoma resection at a single center between January 2008 and January 2021 using procedural terminology codes. Of these, four (0.6%) pediatric patients were excluded, as were five (0.8%) patients with atypical lipomatous tumors and two (0.3%) patients with primary bone tumors; 5% (33 of 623) who were lost to follow-up, leaving 579 for final analysis. The prophylactic antibiotic regimen given at the resection and whether a wound complication occurred were recorded. Patients received the augmented regimen based on whether they underwent resection after the change in practice in July 2018. A total of 497 patients received a standard antibiotic regimen (usually a first-generation cephalosporin), and 82 patients received an augmented regimen with anaerobic coverage (most often metronidazole). Of the 579 patients, 53% (307) were male (53% [264 of 497] in the standard regimen and 52% [43 of 82] in the augmented regimen), and the mean age was 59 ± 17 years (59 ± 17 and 60 ±17 years in the standard and augmented groups, respectively). Wound complications were defined as any of the following within 120 days of the initial resection: formal wound debridement in the operating room, other interventions such as percutaneous drain placement, readmission for intravenous antibiotics, or deep wound packing for more than 120 days from the resection. Patients were considered to have a surgical site infection if positive cultures resulted from deep tissue cultures taken intraoperatively at the time of debridement. The proportion of patients with major wound complications was 26% (150 of 579); it was 27% (136 of 497) and 17% (14 of 82) in the standard and augmented antibiotic cohorts, respectively (p = 0.049). With the numbers we had, we could not document that the addition of antibiotics with anaerobic coverage was associated with lower odds of anaerobic (4% versus 6%; p = 0.51) or polymicrobial infections (9% versus 14%; p = 0.25). Patient, tumor, and treatment (surgical, radiotherapy, and chemotherapy) variables were collected to evaluate factors associated with overall infection and anaerobic or polymicrobial infection. Patient follow-up was 120 days to capture early wound complications. A multivariable analysis was performed for all variables found to be significant in the univariate analysis. A p value < 0.05 was used as the threshold for statistical significance for all analyses. No patients were found to have an adverse reaction to the augmented regimen, including allergic reactions or Clostridioides (formerly Clostridium) difficile infection. RESULTS After controlling for other potentially confounding factors such as neoadjuvant radiation, tumor size and anatomic location, as well as patient BMI, anaerobic coverage was associated with smaller odds of wound complications (OR 0.36 [95% confidence interval (CI) 0.18 to 0.68]; p = 0.003). Other factors associated with major wound complications were preoperative radiation (versus no preoperative radiation) (OR 2.66 [95% CI 1.72 to 4.15]; p < 0.001), increasing tumor size (OR 1.04 [95% CI 1.00 to 1.07]; p = 0.03), patient BMI (OR 1.07 [95% CI 1.04 to 1.11]; p < 0.001), and tumor in the distal upper extremity (versus proximal upper extremity, pelvis/groin/hip, and lower extremity) (OR 0.18 [95% CI 0.04 to 0.62]; p = 0.01). CONCLUSION The addition of anaerobic coverage to the standard prophylactic regimen during soft tissue sarcoma resection demonstrated an association with smaller odds of major wound complications and no documented adverse reactions. Treating physicians should consider these findings but note that they are preliminary, and that further work is needed to replicate them in a more controlled study design such as a prospective trial. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Duncan C. Ramsey
- Department of Orthopaedic Surgery, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | - Jorge R. Walker
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Rebecca Wetzel
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Kenneth R. Gundle
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
- Operative Care Division, Portland Veteran’s Administration Medical Center, Portland, OR, USA
| | - James B. Hayden
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Yee-Cheen Doung
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
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15
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den Hollander D, Van der Graaf WTA, Fiore M, Kasper B, Singer S, Desar IME, Husson O. Unravelling the heterogeneity of soft tissue and bone sarcoma patients' health-related quality of life: a systematic literature review with focus on tumour location. ESMO Open 2021; 5:e000914. [PMID: 33082266 PMCID: PMC7577059 DOI: 10.1136/esmoopen-2020-000914] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022] Open
Abstract
Patients with sarcoma experience many physical and psychological symptoms, adversely affecting their health-related quality of life (HRQoL). HRQoL assessment is challenging due to the diversity of the disease. This review aims to unravel the heterogeneity of HRQoL of patients with sarcoma with regard to tumour location and to summarise the used measures in research. English-language literature from four databases published between January 2000 and April 2019 was reviewed. Studies that described adult sarcoma HRQoL outcomes were included and classified according to primary sarcoma location. Eighty-seven articles met the inclusion criteria covering sarcoma of the extremities (n=35), pelvis and axial skeleton (n=9), pelvis and extremities (n=5), head and neck (n=4), retroperitoneum (n=2) and multiple sarcoma locations (n=33), respectively. Urogenital and thoracic sarcoma were lacking. Fifty-four different questionnaires were used, most often cancer-generic or generic HRQoL questionnaires. Patients with sarcoma reported lower HRQoL than the general population. Distinctive patterns of HRQoL outcomes according to tumour location regarding symptoms, physical functioning, disability and psychosocial well-being were identified. In metastatic sarcoma, mostly constitutional symptoms were present. To comprehensively assess HRQoL, a sarcoma-specific measurement strategy should be developed and used covering the heterogeneity of sarcoma including location-specific issues to improve personalised HRQoL assessment in future research and clinical practice.
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Affiliation(s)
- Dide den Hollander
- Medical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands; Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Winette T A Van der Graaf
- Medical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands; Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marco Fiore
- Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Bernd Kasper
- Sarcoma Unit, University of Heidelberg, Mannheim University Medical Center, Mannheim, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre Mainz, Mainz, Germany
| | - Ingrid M E Desar
- Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga Husson
- Medical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom.
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16
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Radiation Oncology Applications in Plastic and Reconstructive Surgery: A Nonsystematic Review of Concepts and Principles. Plast Reconstr Surg 2021; 147:314e-324e. [PMID: 33565838 DOI: 10.1097/prs.0000000000007582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Careful consideration of radiotherapy can determine the success of reconstructive therapy. There is a broad spectrum of radiotherapy modalities, both benign and malignant. Delivery mechanisms differ in the physical design, setup, radiation source, administrable dosage, and mode of delivery. This range of options allows radiation oncologists to tailor individualized treatment; however, radiotherapy concepts can be challenging for nonspecialists. The purpose of this article is to review general radiation oncology concepts, including essential equipment and radiobiology, and provide plastic surgeons with a basic conceptual understanding to facilitate effective multidisciplinary collaboration with radiation oncologists.
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17
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Blight TJ, Choong PFM. The need for improved patient reported outcome measures in patients with extremity sarcoma: A narrative review. ANZ J Surg 2021; 91:2021-2025. [PMID: 34227237 DOI: 10.1111/ans.17028] [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] [Received: 01/23/2021] [Revised: 06/05/2021] [Accepted: 06/06/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Extremity sarcoma causes impairments to functionality and quality of life. Patient-reported outcome measures (PROMS) assess patient perspectives relating to domains of health and quality of life. METHODS To describe PROMs utilised in extremity sarcoma, the available literature was screened for studies that utilised PROMs to evaluate outcomes in extremity sarcoma following surgery. RESULTS Seventy articles met eligibility criteria; six PROMs were identified. The Toronto Extremity Salvage Score, The Short-Form 36, The EORTC QLQ-C30, The Disabilities of the Arm, Shoulder and Hand questionnaire, the Reintegration to Normal Living index and the Patient-Reported Outcomes Measurement Information System. Most sarcoma patients score well in these tools, with bone sarcoma, and extent of resection being predictors of poor outcomes. CONCLUSION TESS is the only sarcoma-specific PROM, and though a valid assessment of functionality, it has difficulty differentiating patients with minor functional impairments. The absence of a disease-specific measure of health is concerning, as generic tools do not account for the unique experiences sarcoma patients face and may impair their accuracy in analysing intervention effectiveness.
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Affiliation(s)
- Thomas J Blight
- Melbourne Medical School, University of Melbourne, Melbourne, Australia.,Clinical School, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Peter F M Choong
- Department of Surgery, University of Melbourne, Melbourne, Australia.,Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Orthopaedics, St. Vincent's Hospital Melbourne, Melbourne, Australia
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18
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Hoftiezer YAJ, Lans J, van der Heijden BEPA, Chen NC, Eberlin KR, Lozano-Calderón SA. Long-term patient-reported outcome measures following limb salvage with complex reconstruction or amputation in the treatment of upper extremity sarcoma. J Surg Oncol 2021; 123:1328-1335. [PMID: 33650694 DOI: 10.1002/jso.26426] [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] [Received: 11/30/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Yannick A J Hoftiezer
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic, Reconstructive, and Hand Surgery, Radboud UMC, Nijmegen, The Netherlands
| | - Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brigitte E P A van der Heijden
- Department of Plastic, Reconstructive, and Hand Surgery, Radboud UMC, Nijmegen, The Netherlands.,Department of Plastic Surgery, Jeroen Bosch Hospital, Utrecht, The Netherlands
| | - Neal C Chen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle R Eberlin
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderón
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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19
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Perrault DP, Lee GK, Yu RP, Carre AL, Chattha A, Johnson MB, Gardner DJ, Carey JN, Tseng WW, Menendez LR, Wong AK. Risk Factors for Wound Complications After Soft Tissue Sarcoma Resection. Ann Plast Surg 2021; 86:S336-S341. [PMID: 33234885 DOI: 10.1097/sap.0000000000002592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Soft tissue sarcomas are a heterogenous group of malignant tumors that represent approximately 1% of adult malignancies. Although these tumors occur throughout the body, the majority involved the lower extremity. Management may involve amputation but more commonly often includes wide local resection by an oncologic surgeon and involvement of a plastic surgeon for reconstruction of larger and more complex defects. Postoperative wound complications are challenging for the surgeon and patient but also impact management of adjuvant chemotherapy and radiation therapy. To explore risk factors for wound complications, we reviewed our single-institution experience of lower-extremity soft tissue sarcomas from April 2009 to September 2016. We identified 127 patients for retrospective review and analysis. The proportion of patients with wound complications in the cohort was 43.3%. Most notably, compared with patients without wound complications, patients with wound complications had a higher proportion of immediate reconstruction (34.5% vs 15.3%; P = 0.05) and a marginally higher proportion who received neoadjuvant radiation (30.9% vs 16.7%; P = 0.06).
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Affiliation(s)
| | - Gene K Lee
- From the Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles
| | - Roy P Yu
- From the Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles
| | - Antoine Lyonel Carre
- From the Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles
| | | | - Maxwell B Johnson
- From the Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles
| | | | - Joseph N Carey
- From the Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles
| | | | - Lawrence R Menendez
- Department of Orthopedic Surgery, Keck School of Medicine of USC, Los Angeles, CA
| | - Alex K Wong
- From the Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles
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20
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Lansu J, Bovée JVMG, Braam P, van Boven H, Flucke U, Bonenkamp JJ, Miah AB, Zaidi SH, Thway K, Bruland ØS, Baldini EH, Jebsen NL, Scholten AN, van den Ende PLA, Krol ADG, Ubbels JF, van der Hage JA, van Werkhoven E, Klomp HM, van der Graaf WTA, van Coevorden F, Schrage Y, van Houdt WJ, Haas RL. Dose Reduction of Preoperative Radiotherapy in Myxoid Liposarcoma: A Nonrandomized Controlled Trial. JAMA Oncol 2021; 7:e205865. [PMID: 33180100 PMCID: PMC7662477 DOI: 10.1001/jamaoncol.2020.5865] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Currently, preoperative radiotherapy for all soft-tissue sarcomas is identical at a 50-Gy dose level, which can be associated with morbidity, particularly wound complications. The observed clinical radiosensitivity of the myxoid liposarcoma subtype might offer the possibility to reduce morbidity. OBJECTIVE To assess whether a dose reduction of preoperative radiotherapy for myxoid liposarcoma would result in comparable oncological outcome with less morbidity. DESIGN, SETTING, AND PARTICIPANTS The Dose Reduction of Preoperative Radiotherapy in Myxoid Liposarcomas (DOREMY) trial is a prospective, single-group, phase 2 nonrandomized controlled trial being conducted in 9 tertiary sarcoma centers in Europe and the US. Participants include adults with nonmetastatic, biopsy-proven and translocation-confirmed myxoid liposarcoma of the extremity or trunk who were enrolled between November 24, 2010, and August 1, 2019. Data analyses, using both per-protocol and intention-to-treat approaches, were conducted from November 24, 2010, to January 31, 2020. INTERVENTIONS The experimental preoperative radiotherapy regimen consisted of 36 Gy in once-daily 2-Gy fractions, with subsequent definitive surgical resection after an interval of 4 or more weeks. MAIN OUTCOMES AND MEASURES As a short-term evaluable surrogate for local control, the primary end point was centrally reviewed pathologic treatment response. The experimental regimen was regarded as a success when 70% or more of the resection specimens showed extensive treatment response, defined as 50% or greater of the tumor volume containing treatment effects. Morbidity outcomes consisted of wound complications and late toxic effects. RESULTS Among the 79 eligible patients, 44 (56%) were men and the median (interquartile range) age was 45 (39-56) years. Two patients did not undergo surgical resection because of intercurrent metastatic disease. Extensive pathological treatment response was observed in 70 of 77 patients (91%; posterior mean, 90.4%; 95% highest probability density interval, 83.8%-96.4%). The local control rate was 100%. The rate of wound complication requiring intervention was 17%, and the rate of grade 2 or higher toxic effects was 14%. CONCLUSIONS AND RELEVANCE The findings of the DOREMY nonrandomized clinical trial suggest that deintensification of preoperative radiotherapy dose is effective and oncologically safe and is associated with less morbidity than historical controls, although differences in radiotherapy techniques and follow-up should be considered. A 36-Gy dose delivered in once-daily 2-Gy fractions is proposed as a dose-fractionation approach for myxoid liposarcoma, given that phase 3 trials are logistically impossible to execute in rare cancers. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02106312.
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Affiliation(s)
- Jules Lansu
- Sarcoma Unit, Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Pètra Braam
- Department of Radiotherapy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hester van Boven
- Sarcoma Unit, Department of Pathology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Uta Flucke
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Aisha B. Miah
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Shane H. Zaidi
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Khin Thway
- The Institute of Cancer Research, London, United Kingdom
- Sarcoma Unit, Department of Pathology, The Royal Marsden Hospital, London, United Kingdom
| | - Øyvind S. Bruland
- Department of Medical Oncology and Radiotherapy, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elizabeth H. Baldini
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Nina L. Jebsen
- Center for Bone and Soft Tissue Tumors, Department of Oncology, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Center for Cancer Biomarkers, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Astrid N. Scholten
- Sarcoma Unit, Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Piet L. A. van den Ende
- Department of Radiotherapy, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Augustinus D. G. Krol
- Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan F. Ubbels
- Department of Radiotherapy, Groningen University Medical Center, Groningen, the Netherlands
| | - Jos A. van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Houke M. Klomp
- Sarcoma Unit, Department of Surgery, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Frits van Coevorden
- Sarcoma Unit, Department of Surgery, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Yvonne Schrage
- Sarcoma Unit, Department of Surgery, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Winan J. van Houdt
- Sarcoma Unit, Department of Surgery, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rick L. Haas
- Sarcoma Unit, Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
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One-Stage Soft Tissue Reconstruction Following Sarcoma Excision: A Personalized Multidisciplinary Approach Called "Orthoplasty". J Pers Med 2020; 10:jpm10040278. [PMID: 33327387 PMCID: PMC7768416 DOI: 10.3390/jpm10040278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives. Wide surgical resection is a relevant factor for local control in sarcomas. Plastic surgery is mandatory in demanding reconstructions. We analyzed patients treated by a multidisciplinary team to evaluate indications and surgical approaches, complications and therapeutic/functional outcomes. Methods. We analyzed 161 patients (86 males (53%), mean age 56 years) from 2006 to 2017. Patients were treated for their primary tumor (120, 75.5%) or after unplanned excision/recurrence (41, 25.5%). Sites included lower limbs (36.6%), upper limbs (19.2%), head/neck (21.1%), trunk (14.9%) and pelvis (8.1%). Orthoplasty has been considered for flaps (54), skin grafts (42), wide excisions (40) and other procedures (25). Results. At a mean follow-up of 5.3 years (range 2–10.5), patients continuously showed no evidence of disease (NED) in 130 cases (80.7%), were alive with disease (AWD) in 10 cases (6.2%) and were dead with disease (DWD) in 21 cases (13.0%). Overall, 62 patients (38.5%) developed a complication (56 minor (90.3%) and 6 major (9.7%)). Flap loss occurred in 5/48 patients (10.4%). The mean Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) was 74.8 ± 14 and 79.1 ± 13, respectively. Conclusions. Orthoplasty is a combined approach effective in management of sarcoma patients, maximizing adequate surgical resection, limb salvaging and functional recovery. One-stage reconstructions are technically feasible and are not associated with increased risk of complications.
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Krauss S, Goertz O, Pakosch-Nowak D, Daigeler A, Harati K, Lehnhardt M, Held M, Kolbenschlag J. Microvascular tissue transfer after the resection of soft tissue sarcomas. J Plast Reconstr Aesthet Surg 2020; 74:995-1003. [PMID: 33454225 DOI: 10.1016/j.bjps.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 10/30/2020] [Accepted: 11/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Microvascular tissue transfer enables the oncological resection of soft tissue sarcomas of the extremities and the trunk by covering the resulting tissue defects that are often extensive. This study was performed to investigate the long-term survival and functional outcome of patients treated with free flaps after sarcoma resection. METHODS A total of 78 sarcoma patients received microvascular tissue transfer in our institution between March 2003 and January 2013. In a retrospective analysis, we investigated data such as tumor characteristics as well as survival time and disease-free survival. In a prospective analysis, we assessed the functional outcome and the health-associated quality of life with the TESS and SF-36 questionnaire, respectively. RESULTS Seventy patients qualified for disease-free survival after tumor resection, 41 patients remained disease free for over 5 years. Forty-five patients reached a survival time of more than 5 years. The functional results experienced by our patients were good with a mean score of 82.6% in the TESS. The physical health-related quality was lower than in the German norm sample and patients suffering from chronical illnesses or cancer, whereas the mental health was only slightly lower than in the norm sample and higher than in the groups with chronic illnesses or cancer (SF-36). CONCLUSION Microvascular tissue transfer enables tumor resection and limb salvage through the coverage of the resulting defects without impairing patients' prognosis. The long survival times after tumor resection emphasizes the need for good functional results as well as quality of life.
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Affiliation(s)
- Sabrina Krauss
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karl University Tuebingen, Tuebingen, Germany.
| | - Ole Goertz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Martin-Luther-Hospital, Berlin, Germany
| | - Daria Pakosch-Nowak
- D.M.D. Department of Oral and Maxillofacial Surgery, Malteser Hospital Rhein Ruhr, Krefeld-Uerdingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Kamran Harati
- Department of Plastic Surgery, Burn Center, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, Burn Center, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Manuel Held
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Jonas Kolbenschlag
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karl University Tuebingen, Tuebingen, Germany
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L'Hotta AJ, Varughese TE, Lyons KD, Simon L, King AA. Assessments used to measure participation in life activities in individuals with cancer: a scoping review. Support Care Cancer 2020; 28:3581-3592. [PMID: 32285262 DOI: 10.1007/s00520-020-05441-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Individuals with cancer are at high risk for restricted participation in meaningful life activities such as work, school, and social activities. Evaluating participation in life activities is identified as a critical component of rehabilitation referral and triage systems. This scoping review investigates what assessments are used to measure participation in life activities in individuals with cancer. METHODS Six databases were systematically searched using keywords and controlled vocabulary through February 2020. Eligible studies used the term participation in the context of life situations and had an assessment with at least 5 participation-specific questions. RESULTS A total of 4604 unique articles were identified and screened for eligibility. Thirty-two studies were included; 20 unique assessments of participation were identified. Assessments were developed with the primary purpose of measuring participation (n = 8); global or physical function (n = 9); community integration (n = 1); social activity (n = 1); or occupational gaps (n = 1). Most assessments (12/20) were not developed with the purpose of measuring participation and only 4 assessments measured key components of participation other than frequency. CONCLUSION Measuring participation in life activities is a developing area in oncology research. Most studies do not accurately or comprehensively measure this construct. The heterogeneity in assessments used indicates no clear consensus on a gold-standard participation measure for use among cancer survivors. Comprehensively measuring participation will help identify individuals in need of rehabilitation services and is an essential first step to inform the development of targeted interventions to enhance participation.
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Affiliation(s)
| | | | - Kathleen D Lyons
- Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Laura Simon
- Washington University School of Medicine, St. Louis, MO, USA
| | - Allison A King
- Washington University School of Medicine, St. Louis, MO, USA.,St. Louis Children's Hospital, One Children's Place, St. Louis, MO, USA
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Martin E, Dullaart MJ, Verhoef C, Coert JH. A systematic review of functional outcomes after nerve reconstruction in extremity soft tissue sarcomas: A need for general implementation in the armamentarium. J Plast Reconstr Aesthet Surg 2020; 73:621-632. [PMID: 32088187 DOI: 10.1016/j.bjps.2019.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/16/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
Resection of nerves in extremity soft tissue sarcomas (STS) can lead to large functional deficits. Nerve reconstructions are rarely performed and little is known on their outcomes and indications for their use, even though they are essential in restoring sensation in limb salvage procedures. This study investigated current knowledge on functional outcomes and considerations to be taken before performing such reconstructions after sarcoma resection. A systematic search was performed in July 2018 in PubMed and Embase databases according to PRISMA guidelines. Search terms related to "soft tissue sarcoma" and "nerve reconstruction" were used. Studies evaluating functional outcomes after nerve grafting or nerve transfers in extremity STS were included. Qualitative synthesis was performed on all studies. Nineteen studies were included after full-text screening, describing 26 patients. The majority of patients had a nerve reconstruction in the upper extremity (65%). Perioperative radiotherapy was administered in 67% and perioperative chemotherapy in 29% of patients. Nerve grafting was most commonly performed (n = 23) and nerve transfers were performed in six patients. A wide variety of outcome measures were used. Most patients recovered at least some motor function and sensation, but success rates were higher after upper than lower extremity defects. Multimodal treatment did not preclude successful reconstructions. Nerve reconstructions in extremity STS allow the restoration of sensation in limb salvation, even motor nerve function can be restored with satisfactory function. The use of multimodal therapy does not seem to interfere with success. Nerve reconstructions should therefore be considered in STS patients.
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Affiliation(s)
- Enrico Martin
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands.
| | - Max J Dullaart
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Molewaterplein 40, Rotterdam, the Netherlands
| | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands.
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Morbid Obesity Is Associated With an Increased Risk of Wound Complications and Infection After Lower Extremity Soft-tissue Sarcoma Resection. J Am Acad Orthop Surg 2019; 27:807-815. [PMID: 30601370 DOI: 10.5435/jaaos-d-18-00536] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Obesity is associated with wound complications after lower extremity surgery. Excision of soft-tissue sarcomas is urgent, and unlike the elective surgery, obesity cannot be modified preoperatively. The purpose of this study was to evaluate the effect of obesity on treatment outcome. METHODS Six hundred fifty-three patients (343 men; mean age, 56 ± 18 years) with a lower extremity soft-tissue sarcoma were reviewed. The mean body mass index (BMI) was 27.1 ± 5.7 kg/m, with 189 obese patients (29%) having a BMI of ≥30 kg/m and 27 morbidly obese patients (4%) having a BMI of ≥40 kg/m. Complications and functional and oncologic outcomes were compared between groups. RESULTS Two hundred eighty-five patients (40%) sustained a postoperative complication, most commonly a dehiscence (n = 175; 24%) and infection (n = 147; 21%). On multivariate analysis, morbid obesity was associated with wound complications (P = 0.002) and infection (P = 0.01). Morbid obesity was not associated with local tumor recurrence (P = 0.56). No difference was found in the mean Toronto Extremity Salvage Score (P = 0.11) or Musculoskeletal Tumor Society (P = 0.41) scores between the groups. DISCUSSION Morbid obesity was associated with postoperative wound complications and infection. However, after surgery, obese patients can expect no difference in oncologic outcome, with an excellent functional result.
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Resuscitating extremities after soft tissue sarcoma resections: Are functional reconstructions an overlooked option in limb salvage? A systematic review. Eur J Surg Oncol 2019; 45:1762-1769. [DOI: 10.1016/j.ejso.2019.05.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 12/27/2022] Open
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Risk factors for postoperative wound complications after extremity soft tissue sarcoma resection: A systematic review and meta-analyses. J Plast Reconstr Aesthet Surg 2019; 72:1449-1464. [DOI: 10.1016/j.bjps.2019.05.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/28/2019] [Accepted: 05/16/2019] [Indexed: 12/18/2022]
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Piscione J, Barden W, Barry J, Malkin A, Roy T, Sueyoshi T, Mazil K, Salomon S, Dandachli F, Griffin A, Saint-Yves H, Giuliano P, Gupta A, Ferguson P, Scheinemann K, Ghert M, Turcotte RE, Lafay-Cousin L, Werier J, Strahlendorf C, Isler M, Mottard S, Afzal S, Anderson ME, Hopyan S. The Pediatric Toronto Extremity Salvage Score (pTESS): Validation of a Self-reported Functional Outcomes Tool for Children with Extremity Tumors. Clin Orthop Relat Res 2019; 477:2127-2141. [PMID: 31299028 PMCID: PMC7000085 DOI: 10.1097/corr.0000000000000756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/12/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The physical function of children with sarcoma after surgery has not been studied explicitly. This paucity of research is partly because of the lack of a sufficiently sensitive pediatric functional measure. The goal of this study was to establish and validate a standardized measure of physical function in pediatric patients with extremity tumors. QUESTIONS/PURPOSES (1) What is the best format and content for new upper- and lower-extremity measures of physical function in the pediatric population? (2) Do the new measures exhibit floor and/or ceiling effects, internal consistency, and test-retest reliability? (3) Are the new measures valid? METHODS In Phase 1, interviews with 17 consecutive children and adolescents with bone tumors were conducted to modify the format and content of draft versions of the pediatric Toronto Extremity Salvage Score (pTESS). In Phase 2, the pTESS was formally translated into French. In Phase 3, 122 participants between 7 and 17.9 years old with malignant or benign-aggressive bone tumors completed the limb-specific measure on two occasions. Older adolescents also completed the adult TESS. Floor and ceiling effects, internal consistency, test-retest reliability, and validity were evaluated. RESULTS Feedback from interviews resulted in the removal, addition, and modification of draft items, and the pTESS-Leg and pTESS-Arm questionnaires were finalized. Both versions exhibited no floor or ceiling effects and high internal consistency (α > 0.92). The test-retest reliability was excellent for the pTESS-Leg (intraclass correlation coefficient [ICC] = 0.94; 95% CI, 0.90-0.97) and good for the pTESS-Arm (ICC = 0.86; 95% CI, 0.61-0.96). Known-group validity (ability to discriminate between groups) was demonstrated by lower mean pTESS-Leg scores for participants using gait aids or braces (mean = 68; SD = 21) than for those who did not (mean = 87; SD = 11; p < 0.001). There was no significant difference between pTESS arm scores among respondents using a brace (n = 5; mean = 73; SD = 11) and those without (n = 22; mean = 83; SD = 19; p = 0.13). To evaluate construct validity, we tested a priori hypotheses. The duration since chemotherapy correlated moderately with higher pTESS-Leg scores (r = 0.4; p < 0.001) but not with pTESS-Arm scores (r = 0.1; p = 0.80), and the duration since tumor resection correlated moderately with higher pTESS-Leg scores (r = 0.4; p < 0.001) but not pTESS-Arm scores (r = 0.2; p = 0.4). Higher VAS scores (that is, it was harder to do things) antecorrelated with both pTESS versions (pTESS-Leg: r = -0.7; p < 0.001; pTESS-Arm: r = -0.8; p < 0.001). To assess criterion validity, we compared the pTESS with the current "gold standard" (adult TESS). Among adolescents, strong correlations were observed between the TESS and pTESS-Leg (r = 0.97, p < 0.001) and pTESS-Arm (r = 0.9, p = 0.007). CONCLUSIONS Both pTESS versions exhibited no floor or ceiling effects and had high internal consistency. The pTESS-Leg demonstrated excellent reliability and validity, and the pTESS-Arm demonstrated good reliability and reasonable validity. The pTESS is recommended for cross-sectional evaluation of self-reported physical function in pediatric patients with bone tumors. LEVEL OF EVIDENCE Level II, outcome measurement development.
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Affiliation(s)
- Janine Piscione
- J. Piscione, W. Barden, Rehabilitation Department, Hospital for Sick Children, Toronto, Canada J. Barry, H. Saint-Yves, M. Isler, S. Mottard, Service d'orthopédie, Hôpital Maisonneuve-Rosemont et Université de Montréal, Montréal, Canada A. Malkin, T. Roy, S. Hopyan, Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Canada T. Sueyoshi, C. Strahlendorf, Division of Hematology and Oncology, BC Children's Hospital and University of British Columbia, Vancouver, Canada K. Mazil, P. Giuliano, L. Lafay-Cousin, Department of Oncology, Alberta Children's Hospital and University of Calgary, Calgary, Canada S. Salomon, F. Dandachli, R. E. Turcotte, Divisions of Orthopaedic Surgery and Surgical Oncology, McGill University Health Centre and McGill University, Montréal, Canada A. Griffin, P. Ferguson, Division of Orthopaedic Surgery, Mt Sinai Hospital and University of Toronto, Toronto, Canada A. Gupta, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada K. Scheinemann, Division of Hematology/Oncology, McMaster University Health Sciences Centre, Hamilton, Canada M. Ghert, Division of Orthopaedic Surgery, Juravinski Cancer Centre and McMaster University, Hamilton, Canada J. Werier, Division of Paediatric Orthopaedic Surgery, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada S. Afzal, Division of Hematology/Oncology, IWK Health Centre and Dalhousie University, Halifax, Canada M. E. Anderson, Orthopedic Center, Boston Children's Hospital, Jimmy Fund Clinic/Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA S. Hopyan, Program in Developmental and Stem Cell Biology, Hospital for Sick Children, Departments of Surgery and Molecular Genetics, University of Toronto, Toronto, Canada
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Bridgham KM, El Abiad JM, Lu ZA, Bhat D, Darrach H, Morris CD, Levin AS, Sacks JM. Reconstructive limb‐salvage surgery after lower extremity soft tissue sarcoma resection: A 20‐year experience. J Surg Oncol 2019; 119:708-716. [DOI: 10.1002/jso.25358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/16/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Kelly M. Bridgham
- Department of Plastic and Reconstructive SurgeryThe Johns Hopkins University School of MedicineBaltimore Maryland
| | - Jad M. El Abiad
- Department of Orthopaedic SurgeryThe Johns Hopkins University School of MedicineBaltimore Maryland
| | - Zhen A. Lu
- Department of Plastic and Reconstructive SurgeryThe Johns Hopkins University School of MedicineBaltimore Maryland
| | - Deepa Bhat
- Department of Plastic and Reconstructive SurgeryThe Johns Hopkins University School of MedicineBaltimore Maryland
| | - Halley Darrach
- Department of Plastic and Reconstructive SurgeryThe Johns Hopkins University School of MedicineBaltimore Maryland
| | - Carol D. Morris
- Department of Orthopaedic SurgeryThe Johns Hopkins University School of MedicineBaltimore Maryland
| | - Adam S. Levin
- Department of Orthopaedic SurgeryThe Johns Hopkins University School of MedicineBaltimore Maryland
| | - Justin M. Sacks
- Department of Plastic and Reconstructive SurgeryThe Johns Hopkins University School of MedicineBaltimore Maryland
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Houdek MT, Griffin AM, Ferguson PC, Wunder JS. Morbid Obesity Increases the Risk of Postoperative Wound Complications, Infection, and Repeat Surgical Procedures Following Upper Extremity Limb Salvage Surgery for Soft Tissue Sarcoma. Hand (N Y) 2019; 14:114-120. [PMID: 30145914 PMCID: PMC6346361 DOI: 10.1177/1558944718797336] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Obesity is a known risk factor for wound complications; however, unlike elective upper extremity procedures, where obesity can be modified preoperatively, excision of soft tissue sarcomas (STSs) is not elective, and as such, obesity cannot be modified. There is a paucity of data concerning the impact of obesity on wound healing in upper extremity sarcoma surgery. METHODS A total of 261 (159 males and 102 females) patients with a STS of the upper extremity from 2006-2014 were reviewed. The mean age and body mass index (BMI) were 56 (18-97) years and 26.6 (15.4-40.8) kg/m2, respectively. Sixty-nine patients (26%) were classified as obese (BMI ⩾30 kg/m2): class I (obese, BMI = 30-34.9 kg/m2; n = 48, 18%), class II (severely obese, BMI = 35.0-39.9 kg/m2; n = 16, 6%), and class III (morbidly obese, BMI ≥ 40 kg/m2; n = 5, 2%). Functional outcomes were also compared between obese and nonobese patients using the Musculoskeletal Tumor Society (MSTS) 1993 rating system and Toronto Extremity Salvage Scores (TESS). RESULTS Forty-nine patients (19%) sustained a wound dehiscence, delayed healing, or infection. Class III obesity increased the risk of wound complications (hazard ratio [HR] = 8.19, 95% confidence interval [CI] = 1.96-22.96, P < .001) and infection (HR = 10.09, 95% CI = 1.60-34.83, P = .01). There was no difference in the mean TESS (93 vs 90, P = .13) or MSTS93 (95 vs 93, P = .39) between obese and nonobese patients. CONCLUSIONS The results of this study indicate morbid obesity significantly increased the risk of a postoperative wound complication and infection. However, following upper extremity limb salvage surgery, obese patients should expect to have excellent functional outcome.
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Affiliation(s)
- Matthew T. Houdek
- University of Toronto, ON, Canada,Mayo Clinic, Rochester, MN, USA,Matthew T. Houdek, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
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Milgrom DP, Sehdev A, Kays JK, Koniaris LG. Integrating therapies for surgical adult soft tissue sarcoma patients. Transl Gastroenterol Hepatol 2018; 3:88. [PMID: 30603724 PMCID: PMC6286915 DOI: 10.21037/tgh.2018.10.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/25/2022] Open
Abstract
Sarcomas are an uncommon group of over 50 different individual histological malignancies arising from mesenchymal (non-epithelial or connective) tissues. Overall, they constitute 1% of human malignancies with an annual incidence rate of fewer than 5 patients per million. Sarcoma may arise from any mesenchymal cell lineages including fat, muscle, or other connective tissues. Due to the rarity of these groups of malignancies, many subtypes were, and still today, are managed as a single entity. This review focused on soft tissue sarcomas with an emphasis on how to integrate therapies for patients with this rare disorder. The role for surgical resection in cure and palliation as well as the relative benefits of adjuvant therapies such as chemotherapy and radiation therapy are discussed.
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Affiliation(s)
- Daniel P. Milgrom
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Amikar Sehdev
- Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Joshua K. Kays
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Leonidas G. Koniaris
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Kask G, Barner-Rasmussen I, Repo J, Blomqvist C, Tukiainen E. Functional Outcome After Lower Extremity Soft Tissue Sarcoma Treatment: A Pilot Study Based on Translated and Culturally Adapted Measures. Scand J Surg 2018; 108:164-171. [PMID: 30187826 DOI: 10.1177/1457496918798210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The present standard of care in treating lower extremity soft tissue sarcomas is function-sparing, limb-preserving resection and reconstruction with or without oncological therapy. The aim of this pilot study was to test the suitability and adequacy of the Finnish translations of two functional outcome questionnaires (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society score) and to perform a preliminary investigation of functional outcomes of Finnish lower-limb soft tissue sarcoma patients after operative treatment. MATERIALS AND METHODS Between June 2015 and December 2015, consecutive surgically treated outpatients were asked to participate in the study. Demographic, clinical, surgical, and oncological outcome data were collected. Two functional outcome questionnaires were used (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores). A comparative analysis is presented. RESULTS A total of 19 lower-limb soft tissue sarcoma patients with a mean follow-up time of 2 years and 10 months were included. All (n = 19) invited patients participated in the study. Mean age was 62.3 years. In total, 13 had high-grade sarcomas. Eight wounds were closed directly, four used skin grafts, and five required flap reconstructions. One patient required a tumor prosthesis, and one required a rotationplasty. A total of 14 patients received oncological therapy. No problems or difficulties were reported in using and completing the Finnish versions of the Toronto Extremity Salvage Score or Musculoskeletal Tumor Society questionnaires. The overall Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores were 88 and 76, respectively. CONCLUSION This pilot study suggests that the Finnish versions of the Toronto Extremity Salvage Score and Musculoskeletal Tumor Society questionnaires are suitable for measuring functional outcome after lower extremity soft tissue sarcomas treatment. Functional outcomes vary from moderate to excellent.
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Affiliation(s)
- G Kask
- 1 Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - I Barner-Rasmussen
- 1 Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - J Repo
- 1 Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.,2 Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - C Blomqvist
- 2 Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - E Tukiainen
- 1 Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
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Slump J, Hofer SO, Ferguson PC, Wunder JS, Griffin AM, Hoekstra HJ, Bastiaannet E, O'Neill AC. Flap choice does not affect complication rates or functional outcomes following extremity soft tissue sarcoma reconstruction. J Plast Reconstr Aesthet Surg 2018; 71:989-996. [DOI: 10.1016/j.bjps.2018.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 03/18/2018] [Accepted: 04/01/2018] [Indexed: 12/27/2022]
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Radiographic Local Tumor Control and Pain Palliation of Sarcoma Metastases within the Musculoskeletal System with Percutaneous Thermal Ablation. Cardiovasc Intervent Radiol 2018. [DOI: 10.1007/s00270-018-1932-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Winnette R, Hess LM, Nicol SJ, Tai DF, Copley-Merriman C. The Patient Experience with Soft Tissue Sarcoma: A Systematic Review of the Literature. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:153-162. [PMID: 27744499 DOI: 10.1007/s40271-016-0200-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a heterogenous group of rare tumors that involve the connective tissue in the body (e.g. muscle, tendons). As with many rare tumors, little is known about the impact of STS on patient well-being. OBJECTIVE The aim of this review was to better understand current knowledge related to patient experience and quality of life (QOL) following diagnosis of STS. METHODS A systematic review of English-language articles published from 2005 to 2015 was conducted in the PubMed/MEDLINE, Embase, PsychINFO, and Evidence-Based Medicine databases. The review included recent conference proceedings and advocacy websites. Articles were eligible if they included adult STS patient-reported outcomes (PROs) or details on patient experience. RESULTS Overall, 3430 articles were identified and 20 were eligible for inclusion. Of these, 14 were clinical studies that included PRO measures, 1 summarized PRO measures used in STS studies, and 5 described the STS patient experience. Patients with STS report a range of impacts on QOL, including emotional well-being, body image, functional deficit following surgery, and practical considerations such as child care and work. CONCLUSIONS Few studies have published either qualitative or quantitative data on the patient experience with STS. While STS has a measurable impact on QOL, there is a lack of detailed information in the published literature. Although PROs are used in clinical studies of STS, they are not STS-specific and may not capture the unique needs of this population. There is a need for qualitative research to better understand both patient and caregiver experiences in STS.
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Affiliation(s)
| | - Lisa M Hess
- Eli Lilly and Company, Indianapolis, IN, USA
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Slump J, Hofer SOP, Ferguson PC, Wunder JS, Griffin AM, Hoekstra HJ, Bastiaannet E, O'Neill AC. Flap reconstruction does not increase complication rates following surgical resection of extremity soft tissue sarcoma. Eur J Surg Oncol 2017; 44:251-259. [PMID: 29275911 DOI: 10.1016/j.ejso.2017.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/09/2017] [Accepted: 11/19/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Flap reconstruction plays an essential role in the surgical management of extremity soft tissue sarcoma (ESTS) for many patients. But flaps increase the duration and complexity of the surgery and their contribution to overall morbidity is unclear. This study directly compares the complication rates in patients with ESTS undergoing either flap reconstruction or primary wound closure and explores contributing factors. METHODS Eight hundred and ninety-seven patients who underwent ESTS resection followed by primary closure (631) or flap reconstruction (266) were included in this study. Data on patient, tumour and treatment variables and post-operative medical and surgical complications were collected. Univariate and multivariate regression analyses were performed to identify independent predictors of complications. RESULTS Post-operative complications occurred in 33% of patients. Flap patients were significantly older, had more advanced disease and were more likely to require neoadjuvant chemo- and radiotherapy. There was no significant difference in complication rates following flap reconstruction compared to primary closure on multivariate analysis (38 vs 30.9% OR 1.12, CI 0.77-1.64, p = 0.53). Pre-operative radiation and distal lower extremity tumour location were significant risk factors in patients who underwent primary wound closure but not in those who had flap reconstruction. Patients with comorbidities, increased BMI and systemic disease were at increased risk of complications following flap reconstruction. CONCLUSIONS Flap reconstruction is not associated with increased post-operative complications following ESTS resection. Flaps may mitigate the effects of some risk factors in selected patients.
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Affiliation(s)
- Jelena Slump
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada; Department of Surgical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stefan O P Hofer
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada
| | - Anthony M Griffin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada
| | - Harald J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Esther Bastiaannet
- Department of Surgical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anne C O'Neill
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada.
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Gerrand C, Furtado S. Issues of Survivorship and Rehabilitation in Soft Tissue Sarcoma. Clin Oncol (R Coll Radiol) 2017; 29:538-545. [DOI: 10.1016/j.clon.2017.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 03/29/2017] [Accepted: 04/05/2017] [Indexed: 12/31/2022]
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The risk of postoperative complications and functional impairment after multimodality treatment for limb and trunk wall soft-tissue sarcoma: Long term results from a monocentric series. Eur J Surg Oncol 2017; 43:1117-1125. [DOI: 10.1016/j.ejso.2017.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/15/2017] [Accepted: 01/24/2017] [Indexed: 01/27/2023] Open
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Abstract
Most of tumours of the foot are tumour-like (synovial cyst, foreign body reactions and epidermal inclusion cyst) or benign conditions (tenosynovial giant cells tumours, planta fibromatosis). Malignant tumours of the soft-tissue and skeleton are very rare in the foot and their diagnosis is often delayed with referral to specialised teams after initial inappropriate procedures or unplanned excisions. The adverse effect of these misdiagnosed tumours is the increasing rate of amputation or local recurrences in the involved patients. In every lump, imaging should be discussed before any local treatment. Every lesion which is not an obvious synovial cyst or plantar fibromatosis should have a biopsy performed. After the age of 40 years, chondrosarcoma is the most usual malignant tumour of the foot. In young patients bone tumours such as osteosarcoma or Ewing’s sarcoma, are very unusually located in the foot. Synovial sarcoma is the most frequent histological diagnosis in soft tissues. Epithelioid sarcoma or clear cell sarcoma, involve more frequently the foot and ankle than other sites. The classic local treatment of malignant conditions of the foot and ankle was below-knee amputation at different levels. Nowadays, with the development of adjuvant therapies, some patients may benefit from conservative surgery or partial amputation after multidisciplinary team discussions. The prognosis of foot malignancy is not different from that at other locations, except perhaps in chondrosarcoma, which seems to be less aggressive in the foot. The anatomy of the foot is very complex with many bony and soft tissue structures in a relatively small space making large resections and conservative treatments difficult to achieve.
Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160078. Originally published online at www.efortopenreviews.org
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Affiliation(s)
- E Mascard
- Necker University Hospital, 75015 Paris, France
| | - N Gaspar
- Department of Pediatrics, Institute Gustave Roussy, 94805 Villejuif, France
| | - L Brugières
- Department of Pediatrics, Institute Gustave Roussy, 94805 Villejuif, France
| | - C Glorion
- Orthopedic Surgery Department, Necker University Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - S Pannier
- Orthopedic Surgery Department, Necker University Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - A Gomez-Brouchet
- Laboratoire d'anatomie et cytologie pathologiques, Institut Universitaire du Cancer de Toulouse- Oncopole, 1 avenue Irène Joliot-Curie. 31059 Toulouse Cedex 9, France
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Podleska LE, Kaya N, Farzaliyev F, Pöttgen C, Bauer S, Taeger G. Lower limb function and quality of life after ILP for soft-tissue sarcoma. World J Surg Oncol 2017; 15:84. [PMID: 28403880 PMCID: PMC5390463 DOI: 10.1186/s12957-017-1150-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/02/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Isolated limb perfusion with TNF-alpha and melphalan (TM-ILP) in combination with complete tumor resection is an effective treatment option for non-resectable soft-tissue sarcoma of the extremities, with limb salvage rates greater than 80%. The aim of this study was to assess quality of life (QoL) after TM-ILP, also with regard to long-term survival. METHODS We retrospectively examined 27 patients who had primarily non-resectable soft-tissue sarcoma of the leg and who had undergone TM-ILP and complete tumor resection (with limb-sparing intent) during their follow-up examinations using the Quality of Life Questionnaire (QLQ-C30) and the German Short Musculoskeletal Function Assessment (SMFA-D). The results from the QLQ-C30 were compared to the reference values for the general population, to the "all cancer patients" reference values (both reference values published by the European Organization for Research and Treatment of Cancer (EORTC)), and to the reference values of a historical amputation group from the literature. The results of the SMFA were compared with those from a reference group of healthy individuals. RESULTS Surprisingly, we found that the global health status/QoL in the TM-ILP group was not significantly different from the general population or from patients with amputation, but it was higher than that of patients with cancer in general. Concerning the SMFA, we did find functional impairments in patients after TM-ILP compared to the reference group. With regard to long-term survival, we found no time-dependent deterioration in QoL for longer time intervals after treatment. CONCLUSIONS These results support the use of TM-ILP in limb-sparing multimodal therapy settings from a quality-of-life perspective, but they also encourage further research on this matter.
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Affiliation(s)
- Lars Erik Podleska
- Sarcoma Surgery Division, Department of General, Visceral and Transplantation Surgery, University Hospital of Essen and Sarcoma Center at the West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Nevda Kaya
- Sarcoma Surgery Division, Department of General, Visceral and Transplantation Surgery, University Hospital of Essen and Sarcoma Center at the West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Farhad Farzaliyev
- Sarcoma Surgery Division, Department of General, Visceral and Transplantation Surgery, University Hospital of Essen and Sarcoma Center at the West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, University Hospital of Essen and Sarcoma Center at the West German Cancer Center (WTZ), University of Duisburg-Essen, 45147, Essen, Germany
| | - Sebastian Bauer
- Department of Medical Oncology, University Hospital of Essen and Sarcoma Center at the West German Cancer Center (WTZ), University of Duisburg-Essen, 45147, Essen, Germany
| | - Georg Taeger
- Sarcoma Surgery Division, Department of General, Visceral and Transplantation Surgery, University Hospital of Essen and Sarcoma Center at the West German Cancer Center (WTZ), University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
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Ramu EM, Houdek MT, Isaac CE, Dickie CI, Ferguson PC, Wunder JS. Management of soft-tissue sarcomas; treatment strategies, staging, and outcomes. SICOT J 2017; 3:20. [PMID: 28287387 PMCID: PMC5347369 DOI: 10.1051/sicotj/2017010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022] Open
Abstract
Soft-tissue sarcomas (STS) are a rare group of malignant tumors which can affect any age group. For the majority of patients who present with a localized STS, treatment involves a multidisciplinary team decision-making approach ultimately relying on surgical resection with or without adjuvant radiation for successful limb salvage. The goals of treatment are to provide the patient with a functional extremity without local tumor relapse. The purpose of this article is to review the treatment of extremity STS, with a focus on staging, treatment options, and outcomes.
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Affiliation(s)
- Eyal M Ramu
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Matthew T Houdek
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Christian E Isaac
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Colleen I Dickie
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Peter C Ferguson
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Jay S Wunder
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
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Slump J, Ferguson PC, Wunder JS, Griffin AM, Hoekstra HJ, Liu X, Hofer SOP, O'Neill AC. Patient, tumour and treatment factors affect complication rates in soft tissue sarcoma flap reconstruction in a synergistic manner. Eur J Surg Oncol 2017; 43:1126-1133. [PMID: 28222969 DOI: 10.1016/j.ejso.2017.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/11/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Flap reconstruction plays an essential role in the management of soft tissue sarcoma, facilitating wide resection while maximizing preservation of function. The addition of reconstruction increases the complexity of the surgery and identification of patients who are at high risk for post-operative complications is an important part of the preoperative assessment. This study examines predictors of complications in these patients. METHODS 294 patients undergoing flap reconstruction following sarcoma resection were evaluated. Data on patient, tumour and treatment variables as well as post-operative complications were collected. Bivariate and multivariate regression analysis was performed to identify independent predictors of complications. Analysis of synergistic interaction between key patient and tumour risk factors was subsequently performed. RESULTS A history of cerebrovascular events or cardiac disease were found to be the strongest independent predictors of post-operative complications (OR 14.84, p = 0.003 and OR 5.71, p = 0.001, respectively). Further strong independent tumour and treatment-related predictors were high grade tumours (OR 1.91, p = 0.038) and the need for additional reconstructive procedures (OR 2.78, p = 0.001). Obesity had significant synergistic interaction with tumour resection diameter (RERI 1.1, SI 1.99, p = 0.02) and high tumour grade (RERI 0.86, SI 1.5, p = 0.01). Comorbidities showed significant synergistic interaction with large tumour resections (RERI 0.91, SI 1.83, p = 0.02). CONCLUSION Patient, tumour and treatment-related variables contribute to complications following flap reconstruction of sarcoma defects. This study highlights the importance of considering the combined effect of multiple risk factors when evaluating and counselling patients as significant synergistic interaction between variables can further increase the risk of complications.
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Affiliation(s)
- J Slump
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada
| | - P C Ferguson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada
| | - J S Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada
| | - A M Griffin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada
| | - H J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - X Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada
| | - S O P Hofer
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada
| | - A C O'Neill
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada. Anne.O'
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Saebye C, Fugloe HM, Nymark T, Safwat A, Petersen MM, Baad-Hansen T, Krarup-Hansen A, Keller J. Factors associated with reduced functional outcome and quality of life in patients having limb-sparing surgery for soft tissue sarcomas - a national multicenter study of 128 patients. Acta Oncol 2017; 56:239-244. [PMID: 28077014 DOI: 10.1080/0284186x.2016.1268267] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Limb-sparing surgery for sarcomas has become possible in most cases. However, the impact of the procedure on the functional outcome has only been investigated in a few studies. The aim of this study has been to identify tumor- and patient-related factors associated with reduced functional outcome and quality of life after limb-sparing surgery in soft tissue sarcoma patients. MATERIAL AND METHODS In total, 128 patients (mean age = 58, female/male = 54/74) who were treated with limb-sparing surgery without bone resection for soft tissue sarcomas in Denmark during the period 1 January 2009 to 31 December 2011 were included. Patients were asked to participate at least one year after surgery, and patients who had experienced local recurrence or metastatic disease were excluded. The Toronto Extremity Salvage Score (TESS) measured functional disability, while the Musculoskeletal Tumor Society Score (MSTS) measured functional impairment. European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 measured quality of life. Tumor- and patient-related factors (age, gender, tumor depth, tumor size, malignancy, comorbidity, location, and radiotherapy) were extracted from the Danish National Sarcoma Database. Wilcoxon rank-sum test and Kruskal-Wallis were used for univariable analysis. Adjusted odds ratios were estimated by using multiple logistic regression models. RESULTS In the multiple regression analysis, it was found that female gender (p = 0.03), lower extremity tumors (p < 0.01) and radiotherapy (p = 0.02) resulted in an increased risk of a lower TESS score. Initial reduced postoperative function was found to be associated with a lower functional outcome. Patients with reduced functional outcome have increased risk for reduced quality of life (p < 0.01). CONCLUSION The results of this study show that patient- and tumor-related factors have an important role in the functional outcome.
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Affiliation(s)
- Casper Saebye
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Hanna M. Fugloe
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tine Nymark
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Akmal Safwat
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael M. Petersen
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Baad-Hansen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Johnny Keller
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Slump J, Ferguson PC, Wunder JS, Griffin A, Hoekstra HJ, Bagher S, Zhong T, Hofer SO, O'Neill AC. Can the ACS-NSQIP surgical risk calculator predict post-operative complications in patients undergoing flap reconstruction following soft tissue sarcoma resection? J Surg Oncol 2016; 114:570-575. [DOI: 10.1002/jso.24357] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/20/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Jelena Slump
- Division of Plastic and Reconstructive Surgery; Department of Surgical Oncology; University of Toronto; Toronto Canada
- University Health Network; Department of Surgery; University of Toronto; Toronto Canada
| | - Peter C. Ferguson
- University Health Network; Department of Surgery; University of Toronto; Toronto Canada
- University Musculoskeletal Oncology Unit; Department of Surgical Oncology; Mount Sinai Hospital; Toronto Canada
| | - Jay S. Wunder
- University Health Network; Department of Surgery; University of Toronto; Toronto Canada
- University Musculoskeletal Oncology Unit; Department of Surgical Oncology; Mount Sinai Hospital; Toronto Canada
| | - Anthony Griffin
- University Health Network; Department of Surgery; University of Toronto; Toronto Canada
- University Musculoskeletal Oncology Unit; Department of Surgical Oncology; Mount Sinai Hospital; Toronto Canada
| | - Harald J. Hoekstra
- University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Shaghayegh Bagher
- Division of Plastic and Reconstructive Surgery; Department of Surgical Oncology; University of Toronto; Toronto Canada
- University Health Network; Department of Surgery; University of Toronto; Toronto Canada
| | - Toni Zhong
- Division of Plastic and Reconstructive Surgery; Department of Surgical Oncology; University of Toronto; Toronto Canada
- University Health Network; Department of Surgery; University of Toronto; Toronto Canada
| | - Stefan O.P. Hofer
- Division of Plastic and Reconstructive Surgery; Department of Surgical Oncology; University of Toronto; Toronto Canada
- University Health Network; Department of Surgery; University of Toronto; Toronto Canada
| | - Anne C. O'Neill
- Division of Plastic and Reconstructive Surgery; Department of Surgical Oncology; University of Toronto; Toronto Canada
- University Health Network; Department of Surgery; University of Toronto; Toronto Canada
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Sorice SC, Press B, Momeni A. Optimizing functional upper extremity reconstruction-Simultaneous free anterolateral thigh flap and tendon transfers-A case report. Microsurgery 2016; 37:71-74. [PMID: 27580418 DOI: 10.1002/micr.30096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/25/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022]
Abstract
Composite upper extremity defects involving muscle-tendon units are amongst the most formidable reconstructive challenges and mandate functional restoration in addition to stable soft-tissue coverage. Here, the authors present a case of a composite defect involving the extensor muscle-tendon units of the forearm resulting from surgical resection of a recurrent Merkel cell cancer. Functional restoration was achieved via multiple tendon transfers followed by soft tissue coverage with a free anterolateral thigh (ALT) flap. No donor- or recipient-site complications were encountered and complete flap survival was noted. Following a 6-week period of immobilization, physical therapy and range of motion exercises were initiated. Excellent functional outcome and high patient satisfaction were noted at 8 weeks postoperatively. In summary, simultaneous tendon transfers and microsurgical tissue transfer may provide a potentially superior approach for upper extremity reconstruction in complex composite defects. © 2014 Wiley Periodicals, Inc. Microsurgery 37:71-74, 2017.
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Affiliation(s)
- Sarah C Sorice
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Barry Press
- Division of Plastic Surgery, Santa Clara Valley Medical Center, Santa Clara, CA
| | - Arash Momeni
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA
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Knaus WJ, Alluri R, Bakri K, Iorio ML. Oncologic reconstruction of the hand and upper extremity: Maximizing functional outcomes. J Surg Oncol 2016; 113:946-54. [DOI: 10.1002/jso.24196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 01/21/2016] [Indexed: 11/08/2022]
Affiliation(s)
- William J. Knaus
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Ram Alluri
- Department of Orthopaedic Surgery, University of Southern California; Keck School of Medicine; Los Angeles California
| | - Karim Bakri
- Division of Plastic Surgery; Mayo Clinic; Rochester Minnesota
| | - Matthew L. Iorio
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
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Kasprian G, Amann G, Panotopoulos J, Schmidt M, Dominkus M, Trattnig S, Windhager R, Prayer D, Nöbauer-Huhmann I. Peripheral nerve tractography in soft tissue tumors: a preliminary 3-tesla diffusion tensor magnetic resonance imaging study. Muscle Nerve 2015; 51:338-45. [PMID: 24916781 DOI: 10.1002/mus.24313] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This diffusion tensor magnetic resonance imaging (DTI) study aimed to clarify the relationship of peripheral nerves and soft tissue tumors (STTs) in 3D to optimize subsequent treatment. METHODS Twenty-six consecutive STT patients (histologically malignant, n=10; intermediate, n=3; and benign, n=13) underwent 3-Tesla MRI using an echoplanar DTI sequence. Deterministic tractography was performed. Fractional anisotropy (FA) values were measured within peritumoral and distant regions of interest. RESULTS Tractography depicted the 3D course of the sciatic (n=12), femoral (n=2), tibial (n=7), fibular (n=2), median (n=1), musculocutaneous (n=1), and ulnar (n=1) nerves in a regular (n=8 of 18, 44.4%) or thinned (n=7 of 18, 38.9%) fashion. The lowest peritumoral FA values, abrupt thinning, and/or complete discontinuity of trajectories were found in 2 cases with histologically proven tumoral nerve infiltration. CONCLUSIONS DTI clarifies the 3D topography between major peripheral nerves and STTs and may be helpful in the assessment of peripheral nerve infiltration by malignant tumors.
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Affiliation(s)
- Gregor Kasprian
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
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Kang S, Han I, Kim S, Lee Y, Kim M, Kim HS. Outcomes after flap reconstruction for extremity soft tissue sarcoma: A case–control study using propensity score analysis. Eur J Surg Oncol 2014; 40:1101-8. [DOI: 10.1016/j.ejso.2014.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/22/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022] Open
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[Long-term functional results after sarcoma resection]. Chirurg 2014; 85:215-20, 222-3. [PMID: 24595478 DOI: 10.1007/s00104-013-2603-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Multimodal treatment of malignant tumors of the musculoskeletal system with R0 in sano resection plays a key role in prevention of local recurrence in soft tissue and bone sarcoma. In cases of unavoidable neuromuscular or osseous defects, current plastic and orthoplastic reconstruction techniques avoid limb amputation in the majority of patients. Clinical long-term results demonstrate that large resection defects do not necessarily result in impaired limb function if multidisciplinary procedures are integrated. In oncologically necessary major limb amputation, segmental resection and replantation of distal limb parts should be considered which provide end-bearing long stump formation. The functional conditions of long-term surviving elderly patients should be integrated into surgical decision-making and rehabilitation efforts.
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Abstract
The management of complex wounds remains a challenge, and although there have been many promising advances, patients often undergo a morbid and lengthy process to obtain sufficient, satisfactory healing. Sarcoma patients are especially vulnerable to soft tissue wound-healing complications. These patients are often treated with neoadjuvant radiation and/or chemotherapy and have compromised local vascularity to healing tissue. The advent and refinement of wound vacuum-assisted closure technology have been shown to have a tremendous impact. This article reviews the benefits of some novel technologies currently undergoing investigation in orthopedic oncology that will likely have applications in wound management from other causes.
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Affiliation(s)
- Herrick J Siegel
- Orthopaedic Oncology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.
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