Abstract
Purpose
Flap reconstruction has become an essential component in soft tissue sarcoma treatment. However, the clinical features of local recurrence after soft tissue sarcoma resection and flap reconstruction remain unclear. The present study aimed to establish effective follow-up strategies after soft tissue sarcoma resection and flap reconstruction.
Methods
Data from patients who underwent soft tissue sarcoma resection and immediate flap reconstruction were retrospectively reviewed. Follow-up after surgery included history taking and physical examination during every visit to the hospital. Magnetic resonance imaging to evaluate the primary site was performed six months after the end of treatment then annually for ten years. The methods of detection of local recurrence were assessed.
Results
A total of 229 consecutive patients were included in the present study. During a median follow-up period of 40 months, 33 patients (14.4%) developed local recurrence. Twenty-three recurrences that occurred on the margin of the transferred flap were detected as palpable mass prior to radiological assessment; among the remaining ten recurrences that occurred in the deep layer of the transferred flap, six were detected by abnormal clinical findings and four were clinically occult and detected by surveillance radiological assessment.
Conclusions
Surveillance radiological assessment has an important role in early detection of local recurrence that develops in the deep layer of the transferred flap. Therefore, meticulous clinical assessment combined with routine radiological study should be performed during follow-up evaluation for local recurrence after soft tissue sarcoma resection and flap reconstruction.
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References
Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65:5–29
Viñals JM, Rodrigues TA, Sildenikova DP, Payro JM, Porté JA, Suñe CH, Ojeda AL, Vidal JM, Dewever M, Lopez CC, Segu JO, Chavarria FA (2012) Indications of microsurgery in soft tissue sarcomas. J Reconstr Microsurg 28:619–625
López JF, Hietanen KE, Kaartinen IS, Kääriäinen MT, Pakarinen TK, Laitinen M, Kuokkanen H (2015) Primary flap reconstruction of tissue defects after sarcoma surgery enables curative treatment with acceptable functional results: a 7-year review. BMC Surg 15:71
Penna V, Iblher N, Momeni A, Stark GB, Bannasch H (2011) Free tissue transfer in reconstruction following soft tissue sarcoma resection. Microsurgery 31:434–440
Lewis JJ, Leung D, Heslin M, Woodruff JM, Brennan MF (1997) Association of local recurrence with subsequent survival in extremity soft tissue sarcoma. J Clin Oncol 15:646–652
Cheney MD, Giraud C, Goldberg SI, Rosenthal DI, Hornicek FJ, Choy E, Mullen JT, Chen YL, Delaney TF (2014) MRI surveillance following treatment of extremity soft tissue sarcoma. J Surg Oncol 109:593–596
Labarre D, Aziza R, Filleron T, Delannes M, Delaunay F, Marques B, Ferron G, Chevreau C (2009) Detection of local recurrences of limb soft tissue sarcomas: is magnetic resonance imaging (MRI) relevant? Eur J Radiol 72:50–53
Whooley BP, Gibbs JF, Mooney MM, McGrath BE, Kraybill WG (2000) Primary extremity sarcoma: what is the appropriate follow-up? Ann Surg Oncol 7:9–14
Whooley BP, Mooney MM, Gibbs JF, Kraybill WG (1999) Effective follow-up strategies in soft tissue sarcoma. Semin Surg Oncol 17:83–87
Watts AC, Teoh K, Evans T, Beggs I, Robb J, Porter D (2008) MRI surveillance after resection for primary musculoskeletal sarcoma. J Bone Joint Surg (Br) 90:484–487
ESMO/European Sarcoma Network Working Group (2014) Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25:102–112
Kane JM 3rd (2004) Surveillance strategies for patients following surgical resection of soft tissue sarcomas. Curr Opin Oncol 16:328–332
James SL (2008) Davies AM (2008) Post-operative imaging of soft tissue sarcomas. Cancer Imaging 8:8–18
Potter DA, Glenn J, Kinsella T, Glatstein E, Lack EE, Restrepo C, White DE, Seipp CA, Wesley R, Rosenberg SA (1985) Patterns of recurrence in patients with high-grade soft-tissue sarcomas. J Clin Oncol 3:353–366
Eilber FC, Brennan MF, Riedel E, Alektiar KM, Antonescu CR, Singer S (2005) Prognostic factors for survival in patients with locally recurrent extremity soft tissue sarcomas. Ann Surg Oncol 12:228–236
Toulmonde M, Le Cesne A, Mendiboure J, Blay JY, Piperno-Neumann S, Chevreau C, Delcambre C, Penel N, Terrier P, Ranchère-Vince D, Lae M, Le Guellec S, Michels JJ, Robin YM, Bellera C, Italiano A (2014) Long-term recurrence of soft tissue sarcomas: prognostic factors and implications for prolonged follow-up. Cancer 120:3003–3006
Jebsen NL, Engellau J, Engström K, Bauer HC, Monge OR, Muren LP, Eide GE, Trovik CS, Bruland OS (2013) Patterns of local recurrence and dose fractionation of adjuvant radiotherapy in 462 patients with soft tissue sarcoma of extremity and trunk wall. Int J Radiol Oncol Biol Phys 86:949–955
Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF (1996) Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 14:1679–1689
Singer S, Corson JM, Gonin R, Labow B, Eberlein TJ (1994) Prognostic factors predictive of survival and local recurrence for extremity soft tissue sarcoma. Ann Surg 219:165–173
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Fujiki, M., Miyamoto, S., Kobayashi, E. et al. Early detection of local recurrence after soft tissue sarcoma resection and flap reconstruction. International Orthopaedics (SICOT) 40, 1975–1980 (2016). https://doi.org/10.1007/s00264-016-3219-y
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DOI: https://doi.org/10.1007/s00264-016-3219-y