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Assessing the Safety and Utility of Wound VAC Temporization of the Sarcoma or Benign Aggressive Tumor Bed Until Final Margins Are Achieved

  • Sarcoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Local recurrence of microinvasive sarcoma or benign aggressive pathologies can be limb- and life-threatening. Although frozen pathology is reliable, tumor microinvasion can be subtle or missed, having an impact on surgical margins and postoperative radiation planning. The authors’ service has begun to temporize the tumor bed after primary tumor excision with a wound vacuum-assisted closure (VAC) pending formal margin analysis, with coverage performed in the setting of final negative margins.

Methods

This retrospective analysis included all patients managed at a tertiary referral cancer center with VAC temporization after soft tissue sarcoma or benign aggressive tumor excision from 1 January 2000 to 1 January 2019 and at least 2 years of oncologic follow-up evaluation. The primary outcome was local recurrence. The secondary outcomes were distant recurrence, unplanned return to the operating room for wound/infectious indications, thromboembolic events, and tumor-related deaths.

Results

For 62 patients, VAC temporization was performed. The mean age of the patients was 62.2 ± 22.3 years (median 66.5 years; 95% confidence interval [CI] 61.7–72.5 years), and the mean age-adjusted Charlson Comorbidity Index was 5.3 ± 1.9. The most common tumor histology was myxofibrosarcoma (51.6%, 32/62). The mean volume was 124.8 ± 324.1 cm3, and 35.5% (22/62) of the cases were subfascial. Local recurrences occurred for 8.1% (5/62) of the patients. Three of these five patients had planned positive margins, and 17.7% (11/62) of the patients had an unplanned return to the operating room. No demographic or tumor factors were associated with unplanned surgery.

Conclusions

The findings showed that VAC-temporized management of microinvasive sarcoma and benign aggressive pathologies yields favorable local recurrence and unplanned operating room rates suggestive of oncologic and technical safety. These findings will need validation in a future randomized controlled trial.

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Authors and Affiliations

  1. Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA

    Mitchell S. Fourman MD, MPhil, Duncan C. Ramsey MD, MPH, Erik T. Newman MD, Kevin A. Raskin MD & Santiago A. Lozano Calderón MD, PhD

  2. Spine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA

    Joseph H. Schwab MD, MS

  3. Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA

    Yen-Lin Chen MD & Thomas F. DeLaney MD

  4. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA

    Yin P. Hung MD, Ivan Chebib MD, Vikram Deshpande MD, MBBS & G. Petur Nielsen MD

  5. Surgical Oncology Service, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    John T. Mullen MD

Authors
  1. Mitchell S. Fourman MD, MPhil
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  2. Duncan C. Ramsey MD, MPH
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  3. Erik T. Newman MD
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Correspondence to Santiago A. Lozano Calderón MD, PhD.

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Fourman, M.S., Ramsey, D.C., Newman, E.T. et al. Assessing the Safety and Utility of Wound VAC Temporization of the Sarcoma or Benign Aggressive Tumor Bed Until Final Margins Are Achieved. Ann Surg Oncol 29, 2290–2298 (2022). https://doi.org/10.1245/s10434-021-11023-9

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  • DOI: https://doi.org/10.1245/s10434-021-11023-9

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