Diagnostic Accuracy of Imaging Study and the Impact of Clinical Risk Factors on the Presence of Residual Tumor Following Unplanned Excision of Soft Tissue Sarcomas / 대한정형외과학회잡지

PURPOSE: This study examined the diagnostic accuracy of an imaging study to find the factors that affect the presence of residual tumors after an unplanned excision of sarcomas. MATERIALS AND METHODS: Ninety-eight patients, who underwent a re-excision after unplanned surgery between January 2008 and December 2014, were enrolled in this study. Magnetic resonance imaging (MRI) was performed before reoperation in all patients. Positron emission tomography (PET)-computed tomography was performed on 54 patients. A wide re-excision and histology diagnosis were performed in all cases. The clinical variables were evaluated using univariate logistic regression and multivariate logistic regression. RESULTS: The presence of a deep-seated tumor increases the risk of remnant tumors (odds ratio: 3.21, p=0.02, 95% confidence interval: 1.25–8.30). The sensitivity for detecting residual tumors is high in MRI (sensitivity 0.79). CONCLUSION: Deep-seated tumors have a significantly higher risk of remnant tumors. Because the negative predictive value of MRI and PET scans is very low, reoperation should be performed regardless of a negative result.

Reasons and surgical strategy for unplanned resection of 23 soft tissue sarcoma cases / 中国肿瘤临床

Objective:To analyze the reasons for unplanned resection of soft tissue sarcomas and explore the treatment strategies for cancer surgery. Methods: The study included 105 patients with soft tissue sarcomas admitted to the First Affiliated Hospital of Xinjiang Medical University between October 2009 and December 2012. The average age of the patients was 52 years old. Among the patients, 65 were males and 40 were females. Up to 82 patients underwent planned resection (Group A) in our hospital, and 23 underwent unplanned resection (Group B) in other hospitals. Wide excision and radical resection were conducted in Group A, whereas extended resection was performed in Group B. General data, tumor location and size, resection margin, local recurrence and metastasis, and survival were statistically analyzed in the two groups. Results:The proportion attaining the margin of wide excision was obviously lower in Group A than in Group B (P＜0.05). The 3-year survival rate was significantly higher in Group B than in Group A (P=0.001). Within an average follow-up of 18 months (3 months to 36 months) in Group B, 12 patients died, including 9 with tumor metastasis and 3 with other diseases. Within an average follow-up of 23 months (5 months to 36 months) in Group A, 15 patients died, including 12 with tumor metastasis and 3 with other diseases. Conclusion:Compared with planned surgical operation, unplanned resection of soft tissue sarcomas often leads to inadequate resection margin, which results in a high incidence of local recurrence and an increased mortality. Thus, clinicians should attempt to avoid unplanned resection of sarcomas.

Results of Re-Excision Following Unplanned Excision of Soft Tissue Sarcoma: Comparison with the Group of Planned Excision / 대한정형외과학회잡지

PURPOSE: This study was designed to investigate the clinical and oncological results of the unplanned excision group, and to compare the results with those of the planned excision group. MATERIALS AND METHODS: A total of 41 patients who underwent re-excision of sarcoma in Yeungnam University Medical Center, from January 2000 to December 2012, after unplanned excision in local medical centers were reviewed retrospectively. We analyzed the clinical and oncological results according to age, gender, tumor size, depth, and locations. As a control group of planned excision, 81 patients with a similar state, were selected and reviewed among the group of 480 patients who underwent planned excision during the same period. We then compared the results of the two groups. RESULTS: In the unplanned excision group, only the age factor was statistically significant to survival (p=0.048). In comparison of clinical and oncological results of the unplanned and planned excision groups, recurrence rate was 11.1% in the unplanned group, 10.5% in the planned group and did not show statistical significance (p=0.18). Survival rate was 74% in the unplanned group, 76.6% in the planned group and did not show statistical significance (p=0.06). Necessity of additional surgery for coverage of soft tissue defects was 46% in the unplanned group, 14% in the planned group and showed statistical significance (p=0.00). CONCLUSION: No significant difference in survival and local recurrence rate was observed between the groups of re-excision with microscopic remnant tumor after unplanned excision and planned excision. However, unplanned excision might lead to unnecessary additional surgery like skin-graft, skin-flap if it were planned.

Unplanned Excision of Soft Tissue Sarcoma: Patient Profile and Treatment Outcomes / 대한골관절종양학회지

PURPOSE: Unplanned excision of a soft tissue sarcoma is defined as the operation performed for gross removal of a soft tissue sarcoma without regard for preoperative imaging or the necessity to removal a margin of normal tissue covering the cancer. We report our experience of treating primary soft tissue sarcoma after an unplanned excision. MATERIALS AND METHODS: We retrospectively reviewed 31 patients referred to our hospital after unplanned excision at other hospitals for treatment of a STS. The clinical information was reviewed with a focus on the patient's age, gender, tumor location, tumor size, tumor depth, presumptive diagnoses at the previous surgery, refer hospital, definitive diagnosis, interval between the initial and additional surgery and local recurrence. RESULTS: There were 19 males and 12 females with a median age of 48 years (range, 17-75 years) at the time of referral. Seventeen patients (54.8%) had tumors in their lower limb, 6 (19.4%) had tumors in their upper limb, and 8 (25.8%) had tumors in their trunk. Tumor depth could be determined for 8 patients (25.8%), with superficial and 22 deep tumors (71%). The medial interval between unplanned excision to re-excision ranged from 2 weeks to 1 year (median, 5 weeks). Local recurrence was detected in 2 patients. All patients were alive without metastasis at last follow up. CONCLUSION: Even in upper class general hospital, many unplanned excision had been performed, which is considered to be avoided. When the relatively huge mass located in deeper layer it requires enough preoperative imaging studies and biopsy.