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Local Recurrence of Disease after Unplanned Excisions of High-grade Soft Tissue Sarcomas

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Clinical Orthopaedics and Related Research

Abstract

Unplanned excisions of soft tissue sarcomas occur with alarming frequency and result in high rates of residual disease, potentially affecting patient prognosis. To determine if unplanned excisions and residual disease status at tumor bed excision increased local recurrence rates and predicted disease-specific patient survival, we retrospectively reviewed 203 consecutive patients with high-grade soft tissue sarcomas treated operatively and followed for at least 2 years (mean, 4.8 years) or until patient death. Among the 64 patients (32%) who had undergone previous unplanned excisions, six had gross residual disease and 40 of the remaining 58 (69%) had microscopic residual disease in the tumor bed. We observed subsequent local recurrence in nine of the 139 patients (6%) after planned excision compared with 22 patients (34%) after unplanned excision. More patients with unplanned excisions who underwent limb salvage procedures required flap coverage and/or skin grafting with their definitive resection (30% versus 5%). In the unplanned excision cohort, residual disease status at tumor bed excision predicted increased rates of local recurrence and decreased disease-specific survival. Unplanned excisions of high-grade soft tissue sarcomas resulted in increased rates of local recurrence but not disease-specific survival. Residual disease at reexcision predicted the likelihood of local recurrence.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Musculoskeletal Oncology, University of Miami Miller School of Medicine, Miami, FL, USA

    Benjamin K. Potter MD & Sheila C. Adams MD

  2. Integrated Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2A, Room 205, Washington, DC, 20307, USA

    Benjamin K. Potter MD

  3. Musculoskeletal Oncology & Joint Disorders, University of Miami Miller School of Medicine, Miami, FL, USA

    J. David Pitcher Jr. MD

  4. Orthopaedics and Pathology, Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA

    H. Thomas Temple MD

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  1. Benjamin K. Potter MD
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  2. Sheila C. Adams MD
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Correspondence to Benjamin K. Potter MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that this or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that a waiver of informed consent for participating in this study was obtained.

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Potter, B.K., Adams, S.C., Pitcher, J.D. et al. Local Recurrence of Disease after Unplanned Excisions of High-grade Soft Tissue Sarcomas. Clin Orthop Relat Res 466, 3093–3100 (2008). https://doi.org/10.1007/s11999-008-0529-4

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  • DOI: https://doi.org/10.1007/s11999-008-0529-4

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