Impact of Unplanned Resection and Re-excision of a Soft Tissue Sarcoma on Prognosis

• Published in: Cirugia española (English ed.) Vol. 98; no. 5; pp. 281 - 287
• Main Authors: Muñoz Muñoz, Paula, Bajawi Carretero, Mariam, González Barranquero, Alberto, Mena Mateos, Antonio, Corral Moreno, Sara, Sanjuanbenito Dehesa, Alfonso, Cabañas Montero, Jacobo, Lobo Martínez, Eduardo
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España, S.L.U 01.05.2020
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Cirugía; Female; Humans; Local recurrence; Male; Middle Aged; Neoplasm Metastasis - pathology; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging - methods; Neoplasm, Residual - epidemiology; Neoplasm, Residual - pathology; Prognosis; Pronóstico; Recurrencia local; Reintervención; Reintervention; Reoperation - statistics & numerical data; Resección no planificada; Retrospective Studies; Sarcoma - surgery; Sarcoma de partes blandas; Soft Tissue Neoplasms - pathology; Soft tissue sarcoma; Surgery; Survival Analysis; Unplanned excision; Young Adult; Unplanned excision; Resección no planificada; Reintervention; Recurrencia local; Prognosis; Pronóstico; Sarcoma de partes blandas; Surgery; Local recurrence; Reintervención; Soft tissue sarcoma; Cirugía; recurrencia local
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2020.04.009

[Display omitted] Up to 40% of all initial operations for soft tissue sarcoma (STS) are unplanned, which would leave residual macroscopic tumor in more than 50% of the cases. The effect this has on local recurrence rate, metastases rate and survival has never been fully established, due to the lack of randomized studies. Retrospective review of patients with STS treated in our unit between January 2001-January 2016. We classified them whether they had been treated by initial planned or unplanned operation. Outcomes were compared in both groups globally and stage-matched. Endpoints were local recurrence and distant metastases. Twenty-three patients of STS underwent a planned excision and 16 an unplanned excision, 13 of them underwent further re-excision. 40% of patients with planned excision had an advanced stage in regard to the unplanned excision group which presented earlier stages. 77% of patients with unplanned excision had residual tumor identified after surgical re-excision. Local recurrence rate in the unplanned excision group was considerably higher 73.5% vs 43.8%. Metastases rate was lower in planned excision group, 45.5% vs 56.3% (P>.05). The recurrence pattern in the unplanned excision group was unstable, with worse outcomes in earlier stages. The unplanned excision of a soft tissue sarcoma may compromise disease local control, with higher rates of local recurrence and metastases, and worse functional outcomes, despite further oncological treatment. We need to recognize the clinical features for malignancy risk in soft tissue lumps for a safe diagnosis to avoid inadequate resections. Hasta un 40% de los sarcomas de partes blandas (SPB) son resecados de forma no planificada, dejando tumor residual en más del 50% de los casos. La implicación pronóstica de estas resecciones no está claramente definida, dado que existen escasos estudios comparativos que demuestren cómo afecta a la tasa de recurrencia local, de metástasis y de supervivencia. Revisión retrospectiva de pacientes intervenidos de un SPB de enero de 2000 a enero de 2016 clasificándolos respecto a intervención planificada o no planificada. Se compararon las tasas de recurrencia y metástasis en global y por estadios. Veintitrés pacientes con SPB fueron tratados de forma planificada y 16 de forma no planificada, con 13 reintervenciones. El 40% del grupo planificado presentó un estadio avanzado respecto al 20% del grupo no planificado. El 77% de los pacientes con resección no planificada reintervenidos presentaron tumor residual en la pieza. La tasa de recidiva local en el grupo de no planificados fue considerablemente más alta (73,5% frente al 43,8%). La tasa de metástasis en no planificados fue del 45,5%, frente al 56,3% en planificados (p>0,05). En el grupo de no planificados el patrón de recidiva fue más errático con peores resultados en estadios precoces. La resección no planificada de los SPB asocia mayores tasas de recurrencia local y peores resultados funcionales a pesar del manejo oncológico posterior. En las lesiones de partes blandas es fundamental reconocer los signos de alarma que sugieren malignidad para llevar a cabo un estudio diagnóstico específico y evitar resecciones inadecuadas.