The Burden of Unplanned Excision of Soft Tissue Tumours in Developing Countries: A 10-Years’ Experience at a Regional Cancer Centre

Alyaf, Syed; Dev, Kapil; Gurawalia, Jaiprakash; Kurpad, Vishnu; Pandey, Arun K.

doi:10.21767/2254-6081.1000105

Cited by 1 publication

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References 22 publications

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“…This corroborates the expectation that because surgeons are prompted to refer large and deep masses, many inadvertently excised masses would then be superficial and small. 1 , 3 , 5 , 6 , 10 , 14 , 24 Presentation of superficial lesions may be similar to other more common benign soft tissue masses and may seem tempting and easy to remove.…”

Section: Discussionmentioning

confidence: 99%

“…Reported oncologic results range from poor to even superior compared with planned excisions (PE). 3 – 5 In addition, most studies addressing UE of soft tissue sarcomas of the extremities (STSE) come from developed countries; few have been reported from low-to-middle-income countries (LMIC) 3 , 6 , 7 such as the Philippines, where patients can ill-afford the additional costs of repeat surgeries.…”

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confidence: 99%

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Unplanned Excision of Soft Tissue Sarcomas of the Extremities in a Low-to-Middle-Income Country

et al. 2023

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Background Outcomes of unplanned excisions of extremity soft tissue sarcomas (STSE) range from poor to even superior compared with planned excisions in developed countries. However, little is known regarding outcomes in low-to-middle-income countries. This study aimed to determine whether definitively treated STSE patients with a previous unplanned excision have poorer oncologic outcomes compared with those with planned excisions. Patients and Methods Using the database of a single sarcoma practice, we reviewed 148 patients with STSE managed with definitive surgery-78 with previous unplanned excisions (UE) and 70 with planned excisions (PE). Results Median follow-up was 4.4 years. UE patients had more surgeries overall and plastic reconstructions ( P < 0.001). On multivariate analysis, overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were not worse among UE patients compared with PE patients. Negative predictors for LRFS were high tumor grade ( P = 0.031) and an R1 surgical margin ( P < 0.001). High grade ( P <0.001), local recurrence ( P = 0.001), and planned excisions ( P = 0.009) predicted poorer DMFS, while age over 65 years ( P = 0.011) and distant metastasis predicted poorer OS ( P < 0.001). Conclusions We recommend systematic re-excision for patients with unplanned excisions. Our study shows that STSE patients with UE, when subjected to re-excision with appropriate surgical margins, can achieve oncologic results similar to those for PE patients. However, there is an associated increased number of surgeries and plastic reconstruction for UE patients. This underscores the need, especially in a resource-limited setting, for education and collaborative policies to raise awareness about STSE among patients and physicians.

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