title: The impact of previous surgical manipulation of subcutaneous sarcoma on oncologic outcome.
abstract: We prospectively followed 106 consecutive patients referred for surgical treatment of nonmetastatic subcutaneous soft tissue sarcoma to assess whether prior surgical manipulation had an impact on local control and/or disease-free survival. 10 patients had no previous surgical treatment; 11 had only a previous biopsy, 75 had a previous attempted excision, and 10 were referred after the tumor had recurred locally. Histologic grade was inversely associated with overall survival and disease-free survival. Of the 75 patients with previous attempted excision, 22 (29%) had gross residual disease, 27 (36%) had microscopic residual disease, and 26 (35%) had no identifiable residual disease. The 5-year metastasis-free survival was 88%. Local control was obtained in 100% of patients without previous surgical manipulation, 89% of those with previous surgery, and 60% of those who were referred after a local relapse had been recognized. Cox proportional hazards analysis revealed that larger tumor size negatively impacted disease-free survival in those patients who were treated with previous attempted excision. Of those patients with tumors 4 cm or larger and a previous unplanned sarcoma excision, disease-free survival was lower than in those patients referred without previous attempted excision.
  
  
  METHODS
  Prognostic study, Level I-2 (prospective study). See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, St. Vincent Hospital, Indianapolis, IN, 42678, USA. brougraff@aol.com
authors.forename: Bruce T
authors.initials: BT
authors.lastname: Rougraff
authors.forename: Kenneth
authors.initials: K
authors.lastname: Davis
authors.forename: Terence
authors.initials: T
authors.lastname: Cudahy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012509:Sarcoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D015996:Survival Rate