Risk factors for postoperative wound complications after extremity soft tissue sarcoma resection: A systematic review and meta-analyses

Slump, Jelena; Bastiaannet, E.; Halka, Anastassi; Hoekstra, Harald J.; Ferguson, Peter C.; Wunder, Jay S.; Höfer, Stefan; OʼNeill, Anne C.

doi:10.1016/j.bjps.2019.05.041

Cited by 64 publications

(81 citation statements)

References 44 publications

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“…Wound complications are serious adverse effects of any preoperative RT in STS. However, this toxicity could be predicted by assessment of patient-related risk factors, such as smoking, diabetes, obesity, and tumor location (lower limbs) (32). Although larger doses per fraction could theoretically increase the risk of late toxicities, such assumption was neither confirmed in clinical trials with preoperative and definitive HFRT in other neoplasms, i.e., rectal, prostate or lung cancer, nor in presented data regarding HFRT in STS.…”

Section: Discussionmentioning

confidence: 99%

Coronavirus Disease (COVID-19) Outbreak: Hypofractionated Radiotherapy in Soft Tissue Sarcomas as a Valuable Option in the Environment of Limited Medical Resources and Demands for Increased Protection of Patients

Spałek

Rutkowski

2020

Front. Oncol.

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Section: Discussionmentioning

confidence: 99%

Coronavirus Disease (COVID-19) Outbreak: Hypofractionated Radiotherapy in Soft Tissue Sarcomas as a Valuable Option in the Environment of Limited Medical Resources and Demands for Increased Protection of Patients

Spałek

Rutkowski

2020

Front. Oncol.

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“…Despite the low number of patients who received radiotherapy (9%), multivariate analysis indicated that local radiotherapy is a risk factor of periprosthetic infection. As compared with patients treated without radiation, radiotherapy has been demonstrated to be associated with a risk of infection after soft-tissue sarcoma resection, owing to the failure of soft-tissue [ 10 , 21 , 35 , 36 ]. In the treatment strategy of sarcoma, the timing of radiotherapy has remained controversial, because both preoperative and postoperative radiotherapy increase the risk of wound complications.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb

Fujiwara

Ebihara

Kitade

et al. 2020

JCM

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Tumor prostheses for the lower limb following resection of musculoskeletal tumors is useful limb salvage management; however, as compared with routine total joint replacement, an increased incidence of deep periprosthetic infection of tumor prosthesis has been observed. The risk factors for periprosthetic infection of tumor prosthesis remain unclear. This study examines the risk factors and outcomes of periprosthetic infection. This was a retrospective observational study including 121 patients (67 males and 54 females) who underwent tumor prosthesis of the lower limb after resection of musculoskeletal tumors between 1 January 2000 and 30 November 2018. Among a total of 121 tumor prostheses, 7 were total femurs, 47 were proximal femurs, 47 were distal femurs, and 20 were proximal tibias. The incidence of postoperative infection and its risk factors were analyzed. Forty-five patients (37%) had osteosarcoma, 36 patients (30%) had bone metastasis, and 10 patients (8%) had soft-tissue tumors invading the bone. The mean operating time was 229 min, and the mean follow-up duration was 5.9 years. Deep periprosthetic infection was noted in 14 patients (12%). In the multivariate analysis, the risk factors for postoperative infection were identified as being male (hazard ratio [HR], 11.2316; p = 0.0100), soft-tissue tumor (HR, 52.2443; p = 0.0003), long operation (HR, 1.0056; p = 0.0184), and radiotherapy (HR, 6.5683; p = 0.0476). The incidence of periprosthetic infection in our institution was similar to that of previous reports. Patients undergoing tumor prosthesis of the lower limb who were male, had a soft-tissue tumor, were predicted to have a long operation, and who underwent radiation, had an increased possibility of postoperative infection.

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“…Interestingly, we could not identify neoadjuvant radiation therapy as an independent risk factor for wound infections unlike other studies, likely due to the low rate of patients with neoadjuvant radiation therapy in our collective. 15,26 However, other complications were significantly associated with wound infections in our collective. The majority of these complications were postoperative anemia or hemorrhage requiring blood transfusions and/or revisional surgery.…”

Section: Predictors Of Wound Infectionsmentioning

confidence: 67%

“…Obesity had been reported to be an independent risk factor for wound complications after extremity STS resection by prior studies and validated by a recent meta-analysis. 3,15 The ASA-score is a surrogate for general patient morbidity and frailty, for which a strong association with complications exists. 22,23 Tumor-related factors such as size and grade have also been shown to be predictive of wound complications.…”

Section: Predictors Of Wound Infectionsmentioning

confidence: 99%

Antibiotic prophylaxis for prevention of wound infections after soft tissue sarcoma resection: A retrospective cohort study

Dadras

Koepp

Wagner

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: The use of antibiotic prophylaxis for soft tissue sarcoma resection varies widely while little evidence on this topic exists. The aim of this study was to determine the impact of antibiotic prophylaxis on the occurrence of wound infections. Methods: A single institutional retrospective cohort study was performed on patients who underwent truncal or extremity soft tissue sarcoma resection. The use of antibiotic prophylaxis was assessed and univariate and multivariate analysis of predictors of wound infections was performed. Results: Nine hundred and fifty-eight patients could be included. Thirty-two percent of patients had no antibiotic prophylaxis, 44% of patients received single-shot prophylaxis, and 24% of patients received single-shot plus continued antibiotic treatment. Wound infections occurred in 140 patients (15%). Independent risk factors for wound infections upon multivariate analysis were obesity, high American Society of Anesthesiologists (ASA) status, high tumor size and grade, operation time over 120 minutes, and other complications. Antibiotic prophylaxis could not be identified as a protective factor in univariate or multivariate analysis. Conclusions: A favorable effect of antibiotic prophylaxis on the occurrence of wound infections could not be observed. Although more studies on this subject are needed, our data do not support the general use of antibiotic prophylaxis for soft tissue sarcoma resection.

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Risk factors for postoperative wound complications after extremity soft tissue sarcoma resection: A systematic review and meta-analyses

Cited by 64 publications

References 44 publications

Coronavirus Disease (COVID-19) Outbreak: Hypofractionated Radiotherapy in Soft Tissue Sarcomas as a Valuable Option in the Environment of Limited Medical Resources and Demands for Increased Protection of Patients

Coronavirus Disease (COVID-19) Outbreak: Hypofractionated Radiotherapy in Soft Tissue Sarcomas as a Valuable Option in the Environment of Limited Medical Resources and Demands for Increased Protection of Patients

Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb

Antibiotic prophylaxis for prevention of wound infections after soft tissue sarcoma resection: A retrospective cohort study

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