The Impact of Previous Surgical Manipulation of Subcutaneous Sarcoma on Oncologic Outcome

Abstract

Prognostic study, Level I-2 (prospective study). See the Guidelines for Authors for a complete description of levels of evidence.

What Are Risk Factors for Local Recurrence of Deep High-grade Soft-tissue Sarcomas?

“…These findings are compatible with previous observations that patients referred after a local recurrence have an increased risk of developing a subsequent local recurrence [6,11]. This finding supports the hypothesis that local recurrence is rarely the source of metastasis but rather the result of aggressive tumor biology, and both local recurrence at presentation and metastasis at diagnosis may be indicators of higher biologic tumor aggressiveness.…”

“…While patients with unplanned excisions tend to have superficial tumors, other reports show no adverse impact of unplanned excision on local recurrence [2,13]. Additionally, whether local recurrence, when it occurs, lessens the chance of local control of the tumor is also controversial [6,11,16]. While several studies [6,11] report patients who are referred after a local recurrence have an increased risk of developing a subsequent local recurrence after surgery, others suggest local recurrence after definitive surgery loses its prognostic importance on the development of a subsequent local recurrence [16].…”

“…Additionally, whether local recurrence, when it occurs, lessens the chance of local control of the tumor is also controversial [6,11,16]. While several studies [6,11] report patients who are referred after a local recurrence have an increased risk of developing a subsequent local recurrence after surgery, others suggest local recurrence after definitive surgery loses its prognostic importance on the development of a subsequent local recurrence [16]. The effect of local recurrence or unplanned excision on subsequent local recurrence in patients with deep, high-grade tumors may differ from recurrence of unplanned excision of subcutaneous or lowgrade sarcomas; however, there is no large series specifically addressing these issues.…”

“…The effect of local recurrence or unplanned excision on subsequent local recurrence in patients with deep, high-grade tumors may differ from recurrence of unplanned excision of subcutaneous or lowgrade sarcomas; however, there is no large series specifically addressing these issues. We presume (1) positive margins after surgical resection are associated with an increase in local recurrence [3,14], (2) presentation with local recurrence is a risk for subsequent local recurrence [6,11], and (3) unplanned excision may be a risk factor for local recurrence in deep, high-grade soft-tissue sarcomas [2,13].…”

Local Recurrence of Disease after Unplanned Excisions of High-grade Soft Tissue Sarcomas

“…Consequently, tumor bed excision now is recommended after most cases of unplanned excision. However, relatively few authors have examined management and outcome implications of unplanned excisions beyond local residual disease rates [2,7,11,24,37].…”