Session: Sarcoma, Colorectal and Upper GI/Thoracic Virtual Poster Grand Rounds
V69: Re-excision After Unplanned Excision of Soft Tissue Sarcoma Is Associated with High Morbidity and Limited Pathologic Identification of Residual Disease
Research Resident MD Anderson Cancer Center Houston, Texas, United States
Disclosure: Disclosure information not submitted.
Participants should be aware of the following financial/non-financial relationships:
Raymond S. Traweek, MD: Disclosure information not submitted.
Introduction: Unplanned excision (UE) of soft tissue sarcomas (STS) presents a significant management challenge for sarcoma specialists. Current management algorithms recommend re-excision often combined with external beam radiation therapy (EBRT). Active surveillance has been suggested as a safe alternative. We evaluated short-term outcomes and morbidity following re-excision to better understand the risks and benefits of this treatment strategy.
Methods: We conducted a retrospective, single institution review of patients undergoing re-excision following UE of an STS over a five-year period (2016-2021). Eligible patients included adults with pathology-confirmed trunk or extremity STS undergoing re-excision after UE. Patients with physical exam or imaging evidence of gross residual disease and histologies with controversial management were excluded. We evaluated all wound complications within 90 days of surgery, defining major wound complication as Clavien-Dindo Grade 3 or higher, as well as readmissions, details of the re-excision procedure and final pathologic findings.
Results: We identified 67 patients undergoing re-excision after UE of an STS. 45/67 patients (67%) were treated with a combination of EBRT and surgery. Plastic surgery was involved for reconstruction in 48/67 cases (73%). The average soft-tissue defect size following re-excision was 81 cm2. Among cases involving reconstruction, 22 patients (33%) required a rotational or free-flap. The rate of wound complications was 43% (29/67), with 11 (16%) patients having a major wound complication. The rate of reoperation for wound complication was 5/67 patients (7.5%). Importantly, 45 patients (67%) had no evidence of residual disease in the re-excision specimen, whereas 13 (19%) had microscopic disease and 9 (13%) had indeterminate pathology.
Conclusions: Data from our high-volume sarcoma center demonstrate notable morbidity with re-excision resulting in a 40% wound complication rate. This strategy comes into question given limited residual disease at the time of re-excision. Treatment plans and discussions with patients should outline the expected pathologic findings and morbidity of re-excision.
Learning Objectives:
Discuss morbidity of re-excision following unplanned excision of truncal and extremity soft tissue sarcoma
Discuss the role of active surveillance after unplanned excision of truncal and extremity soft tissue sarcoma
Develop strategies for identifying patients appropriate for active surveillance with truncal and extremity soft tissue sarcoma
