Systematic re-excision after unplanned excision beneficial in soft tissue sarcomas

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Amongst patients in low-to-middle-income countries with soft tissue sarcoma of the extremity who previously underwent an unplanned excision, systematic re-excision is recommended to achieve appropriate surgical margins, according to a study.

However, because this leads to more surgeries (including plastic reconstruction) which may be difficult in a resource-limited setting “education and collaborative policies” are needed.

In this study, 148 patients with soft tissue sarcoma of the extremity undergoing definitive surgery, of which 78 had previously undergone an unplanned excision and 70 had planned excisions, were followed for a median of 4.4 years.

Patients who had unplanned excision underwent more surgeries overall and plastic reconstructions (P < 0.001) than those who had planned excisions.

There was no difference in overall survival, local recurrence-free survival, and distant metastasis-free survival between patients with unplanned excision and patients with planned excisions. High tumor grade and an R1 surgical margin were negative predictors for local recurrence-free survival and high grade, local recurrence, and planned excisions predicted poorer distant metastasis-free survival, while age over 65 years and distant metastasis were predictors of poorer overall survival.

“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,” the authors concluded.

Wang EHM, Araneta KTS, Gaston CLL, et al. Unplanned Excision of Soft Tissue Sarcomas of the Extremities in a Low-to-Middle-Income Country. Ann Surg Oncol. 2023;doi: 10.1245/s10434-023-13188-x. Epub ahead of print. PMID: 36800129.