Melis Annemarie S, Vos Melissa, Schuurman Melinda S, van Dalen Thijs, van Houdt Winan J, van der Hage Jos A, Schrage Yvonne M, Been Lukas B, Bonenkamp Johannes B, Bemelmans Marc H A, Grünhagen Dirk J, Verhoef Cornelis, Ho Vincent K Y
Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
Eur J Surg Oncol. 2022 May;48(5):994-1000. doi: 10.1016/j.ejso.2021.11.123. Epub 2021 Nov 19.
Timely recognition of soft tissue sarcomas (STS) remains challenging, potentially leading to unplanned excisions (also known as 'whoops procedures'). This population-based study charted the occurrence of unplanned excisions and identified associated patient, tumour, and treatment-related characteristics. Furthermore, it presents an overview of the outcomes and clinical management following an unplanned excision.
From the Netherlands Cancer Registry (NCR) database, information was obtained on 2187 adult patients diagnosed with STS in 2016-2019 who underwent surgery. Tumours located in the mediastinum, heart or retroperitoneum were excluded, as well as incidental findings. Differences between patients with planned and unplanned excisions were assessed with chi-square tests and a multivariable logistic regression model.
Overall, unplanned excisions comprise 18.2% of all first operations for STS, with a quarter of them occurring outside a hospital. Within hospitals, the unplanned excision rate was 14.4%. Unplanned excisions were more often performed on younger patients, and tumours unsuspected of being STS prior to surgery were generally smaller (≤5 cm) and superficially located. Preoperative imaging was omitted more frequently in these cases. An unplanned excision more often resulted in positive margins, requiring re-excision. Patients who had an unplanned excision outside of a sarcoma centre were more often discussed at or referred to a sarcoma centre, particularly in case of residual tumour.
Potential improvement in preventing unplanned excisions may be achieved by better compliance to preoperative imaging and referral guidelines, and stimulating continuous awareness of STS among general surgeons, general practitioners and private practices.
软组织肉瘤（STS）的及时识别仍然具有挑战性，这可能导致意外切除（也称为“哎呀手术”）。这项基于人群的研究记录了意外切除的发生率，并确定了相关的患者、肿瘤和治疗相关特征。此外，它还概述了意外切除后的结果和临床管理情况。
从荷兰癌症登记处（NCR）数据库中获取了2016年至2019年期间诊断为STS并接受手术的2187名成年患者的信息。位于纵隔、心脏或腹膜后的肿瘤以及偶然发现的肿瘤被排除在外。采用卡方检验和多变量逻辑回归模型评估计划切除和意外切除患者之间的差异。
总体而言，意外切除占所有STS首次手术的18.2%，其中四分之一发生在医院外。在医院内，意外切除率为14.4%。意外切除更常发生在年轻患者身上，术前未怀疑为STS的肿瘤通常较小（≤5厘米）且位于浅表。在这些病例中，术前影像学检查更常被省略。意外切除更常导致切缘阳性，需要再次切除。在肉瘤中心以外进行意外切除的患者更常被讨论或转诊至肉瘤中心，尤其是在有残留肿瘤的情况下。
通过更好地遵守术前影像学检查和转诊指南，以及提高普通外科医生、全科医生和私人诊所对STS的持续认识，可能会在预防意外切除方面取得潜在的改善。
