Pre-operative evaluation prior to soft tissue sarcoma excision – Why can't we get it right?

Mesko, Nathan W.; Wilson, Robert J.; Lawrenz, Joshua M.; Mathieu, J; Ghiam, Michael K.; Mathis, Shannon L.; Halpern, Jennifer L.; Schwartz, Herbert S.; Holt, Ginger E.

doi:10.1016/j.ejso.2017.11.001

Cited by 21 publications

(17 citation statements)

References 28 publications

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“…At our University Hospital's Comprehensive Cancer Center, the whole reconstructive spectrum is available, which allows even extensive resections and complex reconstructions. Detailed preoperative surgical resection planning estimates the expected defect and the specific need for flap reconstruction [8,23]. Our interdisciplinary approach included a comprehensive preoperative discussion about possible intraoperative decision making in terms of defects so that more than one reconstructive option was always planned ahead of the operation.…”

Section: Discussionmentioning

confidence: 99%

The Role of Plastic Reconstructive Surgery in Surgical Therapy of Soft Tissue Sarcomas

Götzl

Sterzinger

Arkudas

et al. 2020

Cancers

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Background: Soft tissue sarcoma (STS) treatment is an interdisciplinary challenge. Along with radio(chemo)therapy, surgery plays the central role in STS treatment. Little is known about the impact of reconstructive surgery on STS, particularly whether reconstructive surgery enhances STS resection success with the usage of flaps. Here, we analyzed the 10-year experience at a university hospital’s Comprehensive Cancer Center, focusing on the role of reconstructive surgery. Methods: We performed a retrospective analysis of STS-patients over 10 years. We investigated patient demographics, diagnosis, surgical management, tissue/function reconstruction, complication rates, resection status, local recurrence and survival. Results: Analysis of 290 patients showed an association between clear surgical margin (R0) resections and higher-grade sarcoma in patients with free flaps. Major complications were lower with primary wound closure than with flaps. Comparison of reconstruction techniques showed no significant differences in complication rates. Wound healing was impaired in STS recurrence. The local recurrence risk was over two times higher with primary wound closure than with flaps. Conclusion: Defect reconstructions in STS are reliable and safe. Plastic surgeons should have a permanent place in interdisciplinary surgical STS treatment, with the full armamentarium of reconstruction methods.

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Section: Discussionmentioning

confidence: 99%

The Role of Plastic Reconstructive Surgery in Surgical Therapy of Soft Tissue Sarcomas

Götzl

Sterzinger

Arkudas

et al. 2020

Cancers

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“…In addition, referral to a sarcoma center should be considered whenever oncologic principles of biopsy or excision cannot be followed. Performing a preoperative biopsy on a suspicious soft tissue mass for a definitive diagnosis is the most important factor in preventing an incomplete STS excision and bad outcome . However, based on such clinical and imaging criteria, several patients with benign soft tissue masses may undergo an invasive procedure for a definitive diagnosis, and patients with an STS may proceed directly to surgery without a preoperative biopsy.…”

Section: Summary Of Available Qualitative and Quantitative Mr‐based Bmentioning

confidence: 99%

Magnetic resonance imaging biomarkers in musculoskeletal soft tissue tumors: Review of conventional features and focus on nonmorphologic imaging

Ahlawat

Fritz

Morris

et al. 2019

Magnetic Resonance Imaging

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The majority of peripheral musculoskeletal soft tissue masses encountered in routine clinical practice are benign and associated with an excellent prognosis, whereas a small proportion of soft tissue masses are malignant and are associated with higher morbidity and mortality. Owing to the excellent tissue contrast resolution provided, magnetic resonance imaging (MRI) is a primary modality for the diagnostic evaluation of soft tissue masses, particularly for defining the anatomic extent. MRI is also useful for the characterization of soft tissue masses; however, after the exclusion of cysts and lipomas, it is challenging to accurately categorize neoplastic lesions as benign or malignant with conventional anatomic MRI. Quantitative MRI biomarkers obtained with nonconventional pulse sequences are becoming increasingly available, and can improve the accuracy of determining the character of soft tissue masses. In this article we discuss established qualitative and emerging quantitative MRI‐based biomarkers available with dynamic contrast‐enhanced MRI, diffusion‐weighted imaging, and MR spectroscopy and their utility for the characterization of untreated soft tissue masses. Level of Evidence: 5 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019;50:11–27.

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“…European Society for Medical Oncology [ESMO] recommendations) is crucial for the further care of these tumors [6]. There is a corpus of literature suggesting that conformity to CPGs remains poor to moderate, although some authors have shown its favorable impact, especially for rare tumors [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Conformity to Clinical Practice Guidelines at Initial Management in Adult Soft Tissue and Visceral Tumors since the Implementation of the NetSarc Network in Eastern France

et al. 2019

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Background Soft tissue sarcomas are rare and heterogenous tumors that are hard to diagnose. The aim of this study was to evaluate local practices and conformity to clinical practice guidelines (CPGs) for their initial diagnostic management. Materials and Methods Patients were carriers of a soft tissue or visceral tumor, presented at a sarcoma tumor board (STB) between 2010 and 2016. Conformity to CPGs was evaluated using ten criteria designed for this purpose. Associations between different factors and conformity to composite criteria, reflecting the three main diagnostic steps (imaging, biopsy and histological report) were analyzed. Results A total of 643 patients were included. A preoperative tumor imaging assessment and a biopsy were performed according to CPGs in 80.8% and 36.8% of the cases, respectively. When done, the first surgical resection was R0 in 30.3% of cases, R1 in 28.6%, and R2 in 10.9%. The rest of the operated patients with sarcoma had a second surgical excision (11.4%), an intraoperative fragmentation (4.3%), or margins were unknown (14.4%). Six of the ten quality criteria presented a conformity rate higher than 70%. Two criteria with a conformity rate lower than 20% were the most controversial: presentation at a STB before biopsy and freezing of a tumor fragment. A multivariate analysis revealed that the common predictor of nonconformity to composite criteria was the initial management in a nonexpert center. Conclusion Initial diagnostic management requires improvement, especially outside of specialized centers. Implications for Practice This article supports the essential need to refer patients with soft tissue tumors to specialized centers to improve the management of sarcomas beginning at the diagnostic phase. Indeed, the reported data were very similar to those already described at the national level of the NetSarc network and indicate the necessity to keep raising awareness about this simple issue: early referral to reference centers will save lives.

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Pre-operative evaluation prior to soft tissue sarcoma excision – Why can't we get it right?

Cited by 21 publications

References 28 publications

The Role of Plastic Reconstructive Surgery in Surgical Therapy of Soft Tissue Sarcomas

The Role of Plastic Reconstructive Surgery in Surgical Therapy of Soft Tissue Sarcomas

Magnetic resonance imaging biomarkers in musculoskeletal soft tissue tumors: Review of conventional features and focus on nonmorphologic imaging

Conformity to Clinical Practice Guidelines at Initial Management in Adult Soft Tissue and Visceral Tumors since the Implementation of the NetSarc Network in Eastern France

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