Department of Orthopedics, Section of Tumor Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines.
Department of Orthopedics, Western Visayas Medical Center, Iloilo City, Philippines.
Ann Surg Oncol. 2023 Jun;30(6):3681-3689. doi: 10.1245/s10434-023-13188-x. Epub 2023 Feb 17.
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.
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).
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).
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.
在发达国家，与计划性切除相比，意外切除肢体软组织肉瘤（STSE）的患者结局从较差到甚至更好。然而，关于中低收入国家的结果知之甚少。本研究旨在确定与计划性切除相比，之前接受过意外切除的确定性治疗的 STSE 患者的肿瘤学结局是否更差。
使用单个肉瘤治疗机构的数据库，我们回顾了 148 名接受确定性手术治疗的 STSE 患者，其中 78 名患者有先前的意外切除（UE），70 名患者有计划性切除（PE）。
中位随访时间为 4.4 年。UE 患者总体上接受了更多的手术和整形重建（P < 0.001）。多因素分析显示，与 PE 患者相比，UE 患者的总生存率（OS）、局部无复发生存率（LRFS）和远处无转移生存率（DMFS）并不差。LRFS 的负预测因素包括高肿瘤分级（P = 0.031）和 R1 手术切缘（P < 0.001）。高级别（P < 0.001）、局部复发（P = 0.001）和计划性切除（P = 0.009）预测 DMFS 较差，而年龄大于 65 岁（P = 0.011）和远处转移预测 OS 较差（P < 0.001）。
我们建议对意外切除的患者进行系统性再切除。我们的研究表明，接受适当手术切缘的 UE 患者可以获得与 PE 患者相似的肿瘤学结果。然而，UE 患者需要进行更多的手术和整形重建。这突出表明，特别是在资源有限的环境中，需要对患者和医生进行关于 STSE 的教育和合作政策，以提高认识。
