Predictors for Major Wound Complications Following Preoperative Radiotherapy and Surgery for Soft-Tissue Sarcoma of the Extremities and Trunk: Importance of Tumor Proximity to Skin Surface

• Published in: Annals of surgical oncology Vol. 20; no. 5; pp. 1494 - 1499
• Main Authors: Baldini, Elizabeth H., Lapidus, Michelle R., Wang, Qian, Manola, Judith, Orgill, Dennis P., Pomahac, Bohdan, Marcus, Karen J., Bertagnolli, Monica M., Devlin, Phillip M., George, Suzanne, Abraham, John, Ferrone, Marco L., Ready, John E., Raut, Chandrajit P.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.05.2013; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Bone and Soft Tissue Sarcomas; Diabetes Complications - complications; Disease-Free Survival; Female; Humans; Lower Extremity; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy - adverse effects; Neoplasm Recurrence, Local; Oncology; Postoperative Complications - etiology; Postoperative Complications - surgery; Radiotherapy, Adjuvant - adverse effects; Sarcoma - pathology; Sarcoma - radiotherapy; Sarcoma - surgery; Skin - pathology; Skin Transplantation; Soft Tissue Neoplasms - pathology; Soft Tissue Neoplasms - radiotherapy; Soft Tissue Neoplasms - surgery; Surgery; Surgical Flaps - adverse effects; Surgical Oncology; Torso; Upper Extremity; Wound Healing; Young Adult; Postoperative Radiation Therapy; Preoperative Radiation Therapy; Skin Surface; Free Flap; Intensity Modulate Radiation Therapy
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-012-2797-1

Purpose Preoperative and postoperative RT for the treatment of high-grade soft-tissue sarcoma result in similar local control and overall survival rates, but morbidities differ. Postoperative RT is associated with a higher rate of long-term fibrosis, edema, and joint stiffness. Preoperative RT is associated with higher rates of wound complications. It is important to identify predictors for major wound complications (MWC) and to develop strategies to minimize this outcome. We reviewed our experience to determine predictors for MWC following preoperative radiotherapy (RT) and surgery for soft-tissue sarcoma. Methods Between January 2006 and May 2011, 103 patients with soft-tissue sarcoma of the extremities and trunk were treated with preoperative RT followed by surgery. MWCs were defined as those requiring operative or prolonged nonoperative management. Fisher’s exact test was used to compare rates. Logistic regression was used for multivariable analysis of factors potentially associated with MWCs. Results Median tumor size was 8.4 cm (range 2–25). All patients had wide or radical resections. Wound closures were primary in 70 %, a vascularized flap in 27 %, and split-thickness skin graft (STSG) in 3 %. There were 36 MWCs (35 %). Significant predictors for MWCs on univariate analysis included diabetes, tumors >10 cm, tumors <3 mm from skin surface, and vascularized flap/STSG closure. The same four variables were significant predictors on multivariable analysis. Conclusions MWCs following preoperative RT and surgery were common. Tumor proximity to skin surface <3 mm is a previously unreported independent predictor, and further strategies to minimize wound complications are needed.