Clinical Problems After Initial Unplanned Resection of Sarcoma

Hoshi, Manabu; Ieguchi, Makoto; Takami, Masatsugu; Aono, Masanari; Taguchi, Susumu; Kuroda, Toshiro; Takaoka, Kunio

doi:10.1093/jjco/hyn093

Cited by 38 publications

(47 citation statements)

References 18 publications

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“…They addressed the significant role of wide reexcision in improving the outcome of unplanned resection compared with inadequate treatment without reexcision. 10 Chandrasekar et al 6 found that despite reexcision, the risk of local recurrence remains high. The risk is doubled when a residual tumor is present in reexcised specimens and for high-grade tumors, marginal reexcision, and deepseated tumors.…”

Section: Impact Of Unplanned Surgery On Prognosismentioning

confidence: 99%

“…2,3,5,9,13,14 According to the definition, 2,3 for the patients presenting after unplanned surgery where margin is uncertain or positive, reexcision is generally recommended. 10,11,15 RT alone without additional excision was occasionally indicated in patients who were either medically inoperable or in whom further surgery would increase morbidity. Bell et al reported a 50% local control (LC) rate for patients who were received RT only without reexcision following unplanned surgery.…”

Section: Does Unplanned Surgery Always Require Reexcision?mentioning

confidence: 99%

“…10,14,18 Delay of a reexcision theoretically allows the proliferation of residual tumor cells, thus increasing the likelihood of local recurrence. Patients' delay was presumed to be one of the main reasons.…”

Section: Reexcision Timingmentioning

confidence: 99%

“…Most series have used at least selective adjuvant therapy after reexcision for high-risk patients following unplanned surgery. 2,6,7,10,15 RT can be administrated prior to, during, or following the reexcision. Regarding the sequencing of RT and reexcision, substantial controversy exists.…”

Section: Adjuvant Radiotherapy and Chemotherapymentioning

confidence: 99%

“…Numerous reports have addressed clinical problems that could occur after initial unplanned excision. 10,11 However, considerable controversy exists regarding the criteria of reexcision and the sequencing of radiation and surgery.…”

Section: Introductionmentioning

confidence: 99%

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Unplanned resection of soft tissue sarcoma

Chen

2015

Formosan Journal of Surgery

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Unplanned surgery of a soft tissue sarcoma is defined as the gross removal of a tumor without appropriate preoperative imaging, biopsy, or attention to the wide surgical margin. Referrals after unplanned surgery account for between 14.7% and 53% of new patients in sarcoma centers. Treatment includes multiple modalities. It has been reported that 35e74% of residual sarcomas are found in reexcised specimens. Therefore, additional reexcision is typically warranted to remove the residual tumor and obtain an adequately safe margin. Adjuvant radiotherapy is generally used if the sarcoma is large, high grade, and deeply located. Adjuvant chemotherapy remains controversial because of its marginal benefits. A recent study indicated that adjuvant chemotherapy, an ifosfamide/epidoxorubicin protocol, showed 19% improvement in overall survival at 4 years. Therefore, adjuvant chemotherapy should be reserved for patients with a large, high-grade, localized lesion, and stage-IV disease. Unplanned surgery of high-grade sarcomas has resulted in increased rates of local recurrence but not disease-specific survival. Adequate additional reexcision may improve local control and survival. To avoid unplanned surgery of soft tissue sarcomas, guidelines have been recommended for clinicians to increase their awareness of the clinical features that suggest malignancy in any soft tissue lump.

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Section: Impact Of Unplanned Surgery On Prognosismentioning

confidence: 99%