Oncological outcome, functional results and costs after unplanned excision of musculoskeletal soft tissue sarcoma

The purpose of this study was to translate the English bone tumour DUX (Bt-DUX-Eng) questionnaire for lower extremity bone tumour patients, a disease-specific quality of life (QoL) instrument, into Italian and then examine the validity of the Italian version of Bt-DUX (Bt-DUX-It). The adaptation and translation process included forward translation, back-translation, and a review of the back-translation by an expert committee. The Bt-DUX-It was validated in a sample of adolescents treated for lower extremity osteosarcoma in Italy. Assessments included the Bt-DUX, the Toronto Extremity Salvage Score (TESS), and the European Organization for Research and Treatment Core Quality of Life Questionnaire of Cancer Patients (EORTC QLQ-C30). Fifty-one patients with a median age of 20 years (range: 15–25) completed the questionnaires. The mean Bt-DUX score was 70 (range: 16.30–100). The internal consistency of the overall score and that of the Bt-DUX-It was good: Cronbach’s α was 0.95. Spearman’s correlation coefficient between the Bt-DUX (total and domain scores) and EORTC QLQ C30 and TESS were overall moderate to good, reaching a p-value <0.01 in all cases. The Bt-DUX-It version is a useful tool for measuring QoL in patients with bone tumour and has similar internal consistency, construct validity, and discrimination as those of the Dutch and English versions.

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“…The TESS score (median 89) was in line with that reported in the literature on comparable populations [ 26 , 27 , 28 ] with similar follow-ups.…”

Section: Discussionsupporting

confidence: 89%

Cross-Cultural Validation of the Italian Version of the Bt-DUX: A Subjective Measure of Health-Related Quality of Life in Patients Who Underwent Surgery for Lower Extremity Malignant Bone Tumour

Morri

Bekkering

Cotti

et al. 2020

Cancers

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“…These results might ascribe the poor prognosis in the UPE group to the residual tumor cells contained in muscular or fascial boundaries or fragmented excision (21). However, the findings of subsequent studies were inconsistent with the above conclusions and demonstrated similar or even better LRFS, MFS, and DSS in patients who underwent re-excision than in those with a planned definitive cancer resection as the primary surgical procedure (9,11,13,22). This contradiction in results can be caused by the difficulty in comparing patients who undergo UPE with patients who undergo PE due to the more favorable tumor features and better biological characteristics (such as smaller size, more superficial location, and more benign) of patients with UPE.…”

Section: Discussionmentioning

confidence: 97%

The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis

Liang

Guo

et al. 2021

Front. Oncol.

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BackgroundUnplanned excision (UPE) of soft tissue sarcoma (STS) is often chosen in the early phase by general physicians without any radiological evaluation.PurposeThe present study aimed to evaluate the impact of UPE on the clinical outcomes of patients with STS of the trunk and extremity.Materials and MethodsPatients with STS of the trunk and extremity who underwent R0 resection between 1998 and 2016 were included and divided into the UPE and planned excision (PE) groups. Propensity score matching (PSM) was used to control the selection bias. The endpoints were disease-specific survival (DSS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS).ResultsIn total, 458 patients (277 males, 181 females; median age: 43 years) were included: 329 (71.8%) in the PE group and 129 (28.2%) in the UPE group. The follow-up time ranged from 7.1 to 313.78 months, with a median of 112.18 months. UPE patients were more likely to have a smaller or superficial lesion and were more frequently administered adjuvant therapy. After PSM, compared with the PE group, the UPE group had a longer LRFS (P=0.015), but there was no difference between the two groups regarding DSS and MFS. Residual disease was observed in 77.5% of the re-resected specimens in the UPE group and was a risk factor for DSS (P = 0.046) and MFS (P = 0.029) but was not associated with local recurrence (LR) (P=0.475) or LRFS (P=0.334). Moreover, we found no difference in DSS, LRFS or MFS according to the interval from UPE to definitive resection.ConclusionSTS treated with UPE had distinct characteristics. Patients who undergo UPE followed by an additional wide R0 resection have similar oncological survival compared to patients who undergo an initial PE, although the high incidence of residual tumor in the UPE group leads to an unfavorable clinical course.

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“…In the present study, additional surgical procedures due to surgical complications may be frequently necessary in patients with additional excision after UE. Morattel et al reported that patients who undergo UE need significantly more procedures, with an average of two more surgical interventions in patients with soft tissue sarcoma (25). This may be because a tumour bed excision in this situation may involve a large skin and soft tissue excision, requiring secondary graft, suture, or flap coverage (6,7,25).…”

Section: Discussionmentioning

confidence: 99%

“…Morattel et al reported that patients who undergo UE need significantly more procedures, with an average of two more surgical interventions in patients with soft tissue sarcoma (25). This may be because a tumour bed excision in this situation may involve a large skin and soft tissue excision, requiring secondary graft, suture, or flap coverage (6,7,25). In soft tissue sarcomas, the tumor size was reported to be an independent prognostic factor for local control (26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Dermatofibrosarcoma Protuberance. Report From the Bone and Soft Tissue Tumor (BSTT) Registry in Japan

Nakamura

Kawai²,

Asanuma

et al. 2021

In Vivo

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Background: Owing to its rarity, dermatofibrosarcoma protuberance (DFSP) is often inappropriately excised. After unplanned excision (UE), additional excision is commonly performed. We aimed to elucidate the effect of additional excision after UE. Patients and Methods: We examined 306 patients with primary DFSP. We analyzed surgical outcomes in 291 patients who received planned excision (PE) or additional excision after UE. Results: Of 306 patients, 194 received PE and the remaining 112 received UE. Of 112 patients, 97 received additional excision after UE. Additional surgery due to complications was more frequent in patients with UE than in those with PE. The 5year local recurrence-free rate in patients without additional excision after UE was significantly worse than that in those with additional excision after UE. Conclusion: If UE is performed, we recommend additional excision for preventing local recurrence; however, the surgical wound should be carefully observed.

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Oncological outcome, functional results and costs after unplanned excision of musculoskeletal soft tissue sarcoma

Cited by 14 publications

References 34 publications

Cross-Cultural Validation of the Italian Version of the Bt-DUX: A Subjective Measure of Health-Related Quality of Life in Patients Who Underwent Surgery for Lower Extremity Malignant Bone Tumour

Cross-Cultural Validation of the Italian Version of the Bt-DUX: A Subjective Measure of Health-Related Quality of Life in Patients Who Underwent Surgery for Lower Extremity Malignant Bone Tumour

The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis

Clinical Outcome of Dermatofibrosarcoma Protuberance. Report From the Bone and Soft Tissue Tumor (BSTT) Registry in Japan

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