Prognosis and surgical outcome of soft tissue sarcoma with malignant fungating wounds

Abstract

Objective Malignant fungating wounds are ulcerating tumors that infiltrate the overlying skin. Little evidence exists regarding the prognosis or treatment of malignant fungating wound in soft tissue sarcoma. This study aimed to reveal the prognosis and outcome of surgical treatment of malignant fungating wound in soft tissue sarcoma. Methods We retrospectively reviewed 26 patients with malignant fungating wound in high-grade soft tissue sarcoma between 2005 and 2018. The patients’ characteristics, treatments, surgical wound complications, local recurrences and prognoses were analyzed. Overall survival was analyzed using the Kaplan–Meier method and compared with that of the control cohort, consisting of 236 consecutive patients with non-malignant fungating wound high-grade soft tissue sarcoma treated during the same period. Results Among the 26 patients, undifferentiated pleomorphic sarcoma was the most common subtype. Twenty-three patients, including 20 (87%) and 3 (13%), underwent limb-salvage surgery and amputation, respectively. Among the 20 patients who underwent limb-salvage surgery, 4 (20%) had surgical wound complications, which required additional surgical procedures. Excluding the patients who underwent palliative surgery, local recurrence occurred in 2 patients (11%). The 5-year overall survival rate for all high-grade malignant fungating wound and non-malignant fungating wound patients was 26.0 and 67.3% (P < 0.0001), respectively. Conclusions Malignant fungating wounds in soft tissue sarcoma were significantly associated with a poor prognosis; however, the incidence of surgical complications and local recurrence after limb-salvage surgery was comparable to that of general soft tissue sarcoma cases. Limb-salvage surgery should be considered, if possible, to preserve the patient’s quality of life because of the dismal prognosis of patients with malignant fungating wound in soft tissue sarcoma.

Impact of Limb Salvage on Prognosis of Patients Diagnosed With Extremity Bone and Soft Tissue Sarcomas

“…In addition to the postoperative survival rate, clinicians are increasingly concerned about the higher recurrence rate and complications caused by limb salvage procedures, as these are associated with a poorer prognosis ( 9 , 10 , 30 ). Some studies have reported no significant difference in the incidence of local recurrence of sarcoma among patients who underwent LSS and amputation ( 8 , 29 ). However, several other studies have implicated LSS with a higher incidence of local recurrence and overall complications ( 31 , 32 ).…”

“…The treatment of sarcoma patients is evolving with the development of multimodality therapy, and advances in imaging techniques and the use of neoadjuvant chemotherapy have resulted in a greater frequency of limb salvage procedures ( 12 , 28 ), which is consistent with our results in this study. Several small samples or single-center clinical cohort studies have shown that LSS had a better prognosis than amputation among patients with EBST sarcomas ( 13 , 29 ). In addition to the postoperative survival rate, clinicians are increasingly concerned about the higher recurrence rate and complications caused by limb salvage procedures, as these are associated with a poorer prognosis ( 9 , 10 , 30 ).…”

Effect of bacterium in the malignant wounds of soft tissue sarcoma

“…In previous reports, patients with MWs from STS were older (mean age: 65-73 years), and presented with higher grade, higher stage, and higher proportion of metastases (20-33%) compared to those without MWs (15)(16)(17)(18). When the lesions are large, possibly requiring skin reconstruction, limb salvage was sometimes difficult, leading to a high rate of amputation (13-33%) (15)(16)(17)(18). Although resection of the tumor can control the symptoms associated with MWs, previous studies reported high rates of surgical site infection (SSI) as much as 26-42% (15,18).…”

“…MWs have some oncologic features in STS; thus, it is important to manage both oncologic and infectious problems. In previous reports, patients with MWs from STS were older (mean age: 65-73 years), and presented with higher grade, higher stage, and higher proportion of metastases (20-33%) compared to those without MWs (15)(16)(17)(18). When the lesions are large, possibly requiring skin reconstruction, limb salvage was sometimes difficult, leading to a high rate of amputation (13-33%) (15)(16)(17)(18).…”

“…When the lesions are large, possibly requiring skin reconstruction, limb salvage was sometimes difficult, leading to a high rate of amputation (13-33%) (15)(16)(17)(18). Although resection of the tumor can control the symptoms associated with MWs, previous studies reported high rates of surgical site infection (SSI) as much as 26-42% (15,18). Hoshi et al reported 42% incidence of postoperative (SSI), and Candida species was the most common isolate, followed by Pseudomonas aeruginosa and Enterococcus species (18).…”