Wise Clare E, Le Chris, Pham Nicole S, New Christin, Kenney Deborah Ellen, Avedian Raffi, Mohler David, Steffner Robert
Department of Orthopedic Surgery, Stanford University 450 Broadway Street Pavilion C, MC 6342 Redwood City, CA 94063, USA.
University of Cincinnati College of Medicine 3230 Eden Avenue Cincinnati, OH 45267, USA.
Surg Oncol. 2025 Oct;62:102273. doi: 10.1016/j.suronc.2025.102273. Epub 2025 Aug 5.
Non-oncologic resection of soft tissue sarcomas (STS) continue to be a common referral to multidisciplinary sarcoma centers. While previous literature has reported tumor characteristics and outcomes related to non-oncologic resections, little is known regarding the surgical specialties most likely to excise such a mass and the non-oncological manner in which they do so. Such information can facilitate preventative strategies.
The goals of this study are: 1) Investigate the surgical specialties that most often perform unplanned excisions and their diagnostic imaging approach, 2) Identify the frequency of non-oncological techniques utilized in initial unplanned excisions, and 3) Define indications for the use of radiation (XRT) in patients with initial non-oncologic resections of STS.
Patient data were collected from a large tertiary referral sarcoma center between 2005 and 2022. Eligible patients had a diagnosis of soft tissue sarcoma that was excised at an outside institution in a non-oncologic manner and subsequently underwent tumor bed re-excision using wide resection. Data regarding the index procedures at outside hospitals were obtained from referral documents and tumor bed re-excisions, along with follow-up care. A total of 124 patients were identified.
Forty-three percent of referrals for non-oncologic resection of soft tissue sarcomas (STS) involved tumors located deep to the fascia. The majority of these referrals originated from General Surgery (N = 54, 44 %), Orthopedic Surgery (N = 35, 28 %), and Plastic Surgery (N = 11, 9 %). Preoperative imaging was conducted in 59 % of cases. General surgeons were less likely to obtain preoperative imaging (p = 0.009) and perform MRI scans (p = 0.013) than orthopaedic surgeons. The proper orientation of the incision based on location was incorrect for general surgeons in 26 % (N = 20) of cases. General surgeons were less likely to make an appropriate incision (p = 0.052) and to use a tourniquet during the initial procedure (p < 0.001). There were no differences among surgical subspecialties in the use of local anesthetic, drain use, or excision type regarding the initial non-oncologic resection. Residual disease following tumor bed re-excision was linked to masses removed in the clinic (p = 0.030) and initial stage IIIB tumors (p = 0.019). Our institutional use of radiation therapy (XRT) correlated with large initial size, high-grade histology, location deep to fascia, and tumors that were re-excised with staged coverage by plastic surgery.
Most referrals for initial non-oncologic resection of STS come from general surgery followed by orthopaedic surgery. Indications for pre-operative MRI imaging, incision orientation, and tourniquet use are education targets for general surgeons in training. Interpretation of MRI scans is an education target for orthopaedic surgeons in training. Clinic procedures are associated with residual disease on tumor re-excision. Radiation before tumor bed re-excision can be considered for larger, high-grade tumors that are deep to the fascia and when plastics coverage is planned.
Level IV.
软组织肉瘤（STS）的非肿瘤性切除仍是多学科肉瘤中心常见的转诊情况。虽然以往文献报道了与非肿瘤性切除相关的肿瘤特征和结局，但对于最有可能切除此类肿块的外科专业以及他们进行切除的非肿瘤学方式知之甚少。此类信息有助于制定预防策略。
本研究的目标是：1）调查最常进行非计划性切除的外科专业及其诊断性影像学方法，2）确定初次非计划性切除中使用的非肿瘤学技术的频率，3）明确初次非肿瘤性切除STS患者使用放疗（XRT）的指征。
收集2005年至2022年期间一家大型三级转诊肉瘤中心的患者数据。符合条件的患者诊断为软组织肉瘤，在外部机构以非肿瘤学方式切除，随后接受肿瘤床再次切除，采用广泛切除。从转诊文件和肿瘤床再次切除以及后续护理中获取外部医院初次手术的数据。共确定了124例患者。
软组织肉瘤非肿瘤性切除转诊患者中，43%的肿瘤位于筋膜深层。这些转诊大多来自普通外科（n = 54，44%）、骨外科（n = 35，28%）和整形外科（n = 11，9%）。59%的病例进行了术前影像学检查。普通外科医生比骨外科医生获得术前影像学检查的可能性更小（p = 0.009），进行MRI扫描的可能性更小（p = 0.013）。26%（n = 20）的病例中，普通外科医生基于位置的切口正确方向有误。普通外科医生进行适当切口的可能性更小（p = 0.052），在初次手术中使用止血带的可能性更小（p < 0.001）。在初次非肿瘤性切除中，各外科亚专业在使用局部麻醉、放置引流管或切除类型方面没有差异。肿瘤床再次切除后的残留疾病与在诊所切除的肿块（p = 0.030）和初始IIIB期肿瘤（p = 0.019）有关。我们机构放疗（XRT）的使用与初始体积大、组织学分级高、位于筋膜深层以及由整形外科分期覆盖再次切除的肿瘤相关。
初次非肿瘤性切除STS的大多数转诊来自普通外科，其次是骨外科。术前MRI成像、切口方向和止血带使用的指征是培训中的普通外科医生的教育目标。MRI扫描解读是培训中的骨外科医生的教育目标。诊所手术与肿瘤再次切除时的残留疾病有关。对于体积大、分级高、位于筋膜深层且计划进行整形外科覆盖的肿瘤，可考虑在肿瘤床再次切除前进行放疗。
IV级。
