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

Wang, Edward H. M.; Araneta, Karla Teresa S.; Gaston, Czar Louie; Rubio, Donnel Alexis; Dios, Ariel M. Vergel De; Cañal, Johanna Patricia A.; Goleta-Dy, Amy N; Alcasabas, Ana Patricia; Odoño, Eugene G; Atun, Jenny Maureen; Fernando, Gracieux Y.; Dimayuga, C.; Quintos, Albert Jerome

doi:10.1245/s10434-023-13188-x

Cited by 6 publications

(10 citation statements)

References 28 publications

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“…The most frequently encountered histology differed across the literature; locally, high-grade liposarcomas The 148 ESTS patients included in Wang et al's study of unplanned excisions without metastasis on presentation were fairly distributed between low-(40%) and highgrade (60%) lesions. 8 In this study of F-ESTS patients, the majority (85%) were high-grade lesions. Comparing the outcomes of this study with Wang et al, there was a slightly higher local recurrence (25% vs 23%), almost double the rate of distant metastasis (65% vs 36%), and nearly half the survival rate (35% vs 63%).…”

Section: Discussionmentioning

confidence: 60%

“…Published data of non-metastatic ESTS cases in the same sarcoma unit would show an aggregate amputation rate of 12.8%. 8 The amputation rate of our F-ESTS study (40%) was much higher, considering the overwhelmingly high-grade nature of this group. Tumor size did not seem to be a factor in amputation since the size of F-ESTS was no different than the average size of STS presenting at the sarcoma unit (~11 cm).…”

Section: Discussionmentioning

confidence: 63%

“…Comparing the outcomes of this study with Wang et al, there was a slightly higher local recurrence (25% vs 23%), almost double the rate of distant metastasis (65% vs 36%), and nearly half the survival rate (35% vs 63%). 8 The patients in this study had half the survival rate of the aggregate STS population treated at the sarcoma unit (64%). These crude differences may be attributed not only to fungation but also to the concentration of high-grade tumors in our study and the inclusion of M1 cases on presentation.…”

Section: Discussionmentioning

confidence: 77%

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Characteristics, Treatment Patterns, and Clinical Outcomes of Patients Diagnosed with Fungating Soft Tissue Sarcomas

Araneta,

Sebastian,

Wang

2024

PJO

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Objectives. A fungating soft tissue sarcoma of the extremities (F-ESTS) is a rare clinical presentation with limited literature. This study aims to describe the important clinical characteristics, treatment patterns, and outcomes of twenty patients diagnosed with F-ESTS and treated by a single surgeon at a sarcoma unit.Methodology. We conducted a retrospective clinical study on twenty F-ESTS patients treated by a single surgeon at a sarcoma unit over 25 years .Results. The local incidence of F-ESTS was 10.9%. The mean age of patients was 49.2 years old. The most common site of occurrence was the thigh (50%) with an average size of 11.8 cm. Most tumors were deep (65%) and high grade (85%). Liposarcomas were the most common histologic diagnosis (35%). Limb salvage was done in 60% of the patients with 50% requiring reconstructive procedures. Fifteen percent of patients developed complications, 25% had local recurrence, and 65% developed distant metastases. The mean survival for this cohort was 49.2 months. Sixty percent of patients died of disease. Conclusion.The majority of F-ESTS patients were younger than 65 years old, had deep and high-grade tumors, predominantly liposarcomas, most commonly found in the thigh, and had a history of surgery or biopsy. In the last 10 years, limb salvage surgery has become the treatment of choice even for patients with fungating sarcomas. Most F-ESTS patients in our study were still able to undergo limb salvage surgery. Local recurrence was seen in five (25%) patients, while thirteen (65%) patients had distant metastases. Twelve (60%) patients had died of disease.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 77%

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Characteristics, Treatment Patterns, and Clinical Outcomes of Patients Diagnosed with Fungating Soft Tissue Sarcomas

Araneta,

Sebastian,

Wang

2024

PJO

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“…Nonetheless, one must be aware that re-resections entail a higher risk of necessitating flap coverage or skin grafting when compared to primary resections [12,16,24]. This risk is particularly elevated in tumors of the distal extremities, including the hand and foot [25].…”

Section: Discussionmentioning

confidence: 99%

Unplanned Resections of Soft Tissue Sarcomas—Necessity of Re-Resection?

Fromm,

Klein,

Mentrup

et al. 2024

Cancers

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Background: In soft tissue sarcomas, unplanned resections, or so-called Whoops procedures, do occur quite frequently, thus primarily owing to the abundant presence of benign lesions. Whether re-resection reduces local recurrence or improves overall survival remains a topic of ongoing debate. The principle objective of this study was to analyze the outcomes of patients with soft tissue sarcomas of the extremities or trunk wall after an incidental marginal resection by comparing re-resections to individuals who declined the procedure. Methods: A total of 185 patients who underwent unplanned resection were included. These patients were stratified into two groups: Group A (n = 156) underwent re-excision, while Group B (n = 29) was treated conservatively. Depending on the clinical scenario, radio- or chemotherapy was either administered in a neoadjuvant or an adjuvant setting. The presence of residual tumor and metastatic disease was documented. Clinical outcomes, specifically local recurrence (LR), local recurrence-free survival (LRFS) and overall survival (OS), were utilized for evaluation. Results: Group B exhibited significantly larger tumors (p < 0.0001) and a higher mean age than Group A. Among the patients in Group A, 11 (5.9%) had contaminated resection margins (R1), and residual disease (RD) was observed in 93 (59.6%) of the resected specimens. In group B, 10 patients received adjuvant radiotherapy alone, 5 received chemotherapy alone, and 13 underwent a combined approach consisting of both radio- and chemotherapy. In Group A, 8% (n = 12) of the patients developed local recurrence (LR) during the observation period. Conversely, in Group B, this amount was 14% (n = 4) (n.s.). Of the 12 LR in Group A, 10 were found in the subgroup with residual disease. Overall survival and local recurrence-free survival were not significantly different between the groups. A total of 15% (n = 24) of the patients in Group A developed metastatic disease, while 10% (n = 3) in Group B developed metastatic disease (n.s.). Conclusions: Following the reresection of unplanned resected STS, there was no statistically significant difference observed in overall survival or LR compared to patients who did not undergo re-resection. However, within the subgroup of patients with residual disease in the re-resected specimen, the OS was compromised, and the LR rate was higher. Particularly for low-grade lesions, adopting a more conservative approach seems to be justified.

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“…In cases with UE, Giuliano et al recommended definitive treatment with reoperation, either with or without radiotherapy. Recent studies have reported worse outcomes in patients with STS and a history of UE [8][9][10]. Consequently, the current standard of care for individuals who have undergone UE involves tumor bed excision with or without neo-adjuvant therapy.…”

Section: Introductionmentioning

confidence: 99%

Is Unplanned Excision of Soft Tissue Sarcomas Associated with Worse Oncological Outcomes?—A Systematic Review and Meta-Analysis

Larios,

Gonzalez,

Ruiz-Arellanos

et al. 2024

Cancers

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Background: Soft tissue sarcomas are a group of rare neoplasms which can be mistaken for benign masses and be excised in a non-oncologic fashion (unplanned excision). Whether unplanned excision (UE) is associated with worse outcomes is highly debated due to conflicting evidence. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines. Main outcomes analyzed were five-year overall survival (OS), five-year local recurrence-free survival (LRFS), amputation rate and plastic reconstruction surgery rate. Risk ratios were used to compare outcomes between patients treated with planned and unplanned excision. Results: We included 16,946 patients with STS, 6017 (35.5%) with UE. UE was associated with worse five-year LRFS (RR 1.35, p = 0.019). Residual tumor on the tumor bed was associated with lower five-year LRFS (RR = 2.59, p < 0.001). Local recurrence was associated with worse five-year OS (RR = 1.82, p < 0.001). UE was not associated with a worse five-year OS (RR = 0.90, p = 0.16), higher amputation rate (RR = 0.77, p = 0.134), or a worse plastic reconstruction surgery rate (RR = 1.25, p = 0.244). Conclusions: Unplanned excision of Soft Tissue Sarcomas and the presence of disease in tumor bed after one were associated with worse five-year LRFS. Tumor bed excision should remain the standard approach, with special consideration to the presence of residual disease.

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

Cited by 6 publications

References 28 publications

Characteristics, Treatment Patterns, and Clinical Outcomes of Patients Diagnosed with Fungating Soft Tissue Sarcomas

Characteristics, Treatment Patterns, and Clinical Outcomes of Patients Diagnosed with Fungating Soft Tissue Sarcomas

Unplanned Resections of Soft Tissue Sarcomas—Necessity of Re-Resection?

Is Unplanned Excision of Soft Tissue Sarcomas Associated with Worse Oncological Outcomes?—A Systematic Review and Meta-Analysis

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