The role of plastic surgery in sarcoma treatment

Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. Wide excision is the mainstay of treatment for localized sarcoma, and associated preoperative or postoperative radiotherapy should be administered in high-risk patients. Adjuvant chemotherapy was associated with a modest improvement in survival in a meta-analysis and constitutes a standard option in selected patients with high-risk STS. In metastatic patients, surgery must be evaluated in selected cases. In the rest of patients, chemotherapy and, in some subtypes, targeted therapy often used in a sequential strategy constitutes the treatment of election. Despite important advances in the understanding of the pathophysiology of the disease, the advances achieved in therapeutic results may be deemed still insufficient. Moreover, due to the rarity and complexity of the disease, the results in clinical practice are not always optimal. For this reason, the Spanish Group for Research on Sarcoma (GEIS) has developed a multidisciplinary clinical practice guidelines document, with the aim of facilitating the diagnosis and treatment of these patients in Spain. In the document, each practical recommendation is accompanied by level of evidence and grade of recommendation on the basis of the available data.

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“…Surgery for expanding margins must be more radical, and therefore, reconstruction procedures tend to be more complex [ 19 – 21 ].…”

Section: Treatment Of Localized Diseasementioning

confidence: 99%

Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

Muro

Álava

Artigas

et al. 2015

Cancer Chemother Pharmacol

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“…In addition, we had a 9% amputation rate, which is comparable with other published series. 4 Reconstruction after soft tissue sarcoma resection can be complicated, as these figures demonstrate, yet the financial reimbursement received by our centre is extremely poor. Financial reimbursement of sarcoma remains complex and an understanding of the reconstructive surgery involved is a key element in coding.…”

Section: Financial Remunerationmentioning

confidence: 99%

Reconstruction and Financial Remuneration Following Soft Tissue Sarcoma Surgery

et al. 2013

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Soft tissue sarcomas are relatively uncommon, with approximately 3,200 new cases per year in the UK, accounting for 1% of all malignancies. They are a heterogeneous group of malignancies that occur anywhere in the body, and arise from the mesenchyme inclusive of muscle, endothelial cells, cartilage and supporting elements. Diagnosis is based on triple assessment with clinical history, imaging and diagnostic biopsy. Histological stage and grade is based on the Trojani classification. Owing to their complex nature, a specialist sarcoma multidisciplinary team (MDT) manages patients. Treatment options include one or more of surgery with wide or planned marginal excision, isolated limb perfusion, chemotherapy or radiotherapy. Long-term follow-up to rule out recurrence of disease is mandatory.

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“…In addition, although plastic surgeons are regularly consulted on a wide variety of medical procedures and are primary members of many interprofessional treatment plans, little research has been conducted to delineate the cost-effectiveness of including a plastic surgeon on a multidisciplinary team. [20][21][22][23][24][25][26][27] Importantly, we consider cost-effectiveness as the financial impact of the addition of a plastic surgeon, which frequently translates to cost savings. In this systematic review, we assess existing literature to determine how cost savings in health care systems are affected by the involvement of plastic surgery in team-based interventions.…”

mentioning

confidence: 99%

“…There exists a need for health care solutions that demonstrate both health-related and financial benefits. In addition, although plastic surgeons are regularly consulted on a wide variety of medical procedures and are primary members of many interprofessional treatment plans, little research has been conducted to delineate the cost-effectiveness of including a plastic surgeon on a multidisciplinary team 20–27 . Importantly, we consider cost-effectiveness as the financial impact of the addition of a plastic surgeon, which frequently translates to cost savings.…”

mentioning

confidence: 99%

Cost-effectiveness of Multidisciplinary Care in Plastic Surgery

et al. 2021

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Background Multidisciplinary care has been previously shown to improve outcomes for patients and providers alike, fostering interprofessional collaboration and communication. Many studies have demonstrated the beneficial health care outcomes of interdisciplinary care. However, there has been minimal focus on the cost-effectiveness of such care, particularly in the realm of plastic surgery. This is the first systematic review to examine cost savings attributable to plastic surgery involvement in multidisciplinary care. Methods A comprehensive literature review of articles published on cost outcomes associated with multidisciplinary teams including a plastic surgeon was performed. Included articles reported on cost outcomes directly or indirectly attributable to a collaborative intervention. Explicitly reported cost savings were totaled on a per-patient basis. Each article was also reviewed to determine whether the authors ultimately recommended the team-based intervention described. Results A total of 604 articles were identified in the initial query, of which 8 met the inclusion criteria. Three studies reported explicit cost savings from multidisciplinary care, with cost savings ranging from $707 to $26,098 per patient, and 5 studies reported changes in secondary factors such as complication rates and length of stay. All studies ultimately recommended multidisciplinary care, regardless of whether cost savings were achieved. Conclusions This systematic review of the cost-effectiveness of multidisciplinary plastic surgery care examined both primary cost savings and associated quality outcomes, such as length of stay, complication rate, and resource consumption. Our findings indicate that the inclusion of plastic surgery in team-based care provides both direct and indirect cost savings to all involved parties.

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The role of plastic surgery in sarcoma treatment

Abstract: Primary reconstructive surgery has a fundamental role in sarcoma treatment enabling radical surgical resection, avoiding amputations and facilitating adjuvant treatments.

Cited by 4 publications

References 22 publications

Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

Reconstruction and Financial Remuneration Following Soft Tissue Sarcoma Surgery

Cost-effectiveness of Multidisciplinary Care in Plastic Surgery

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