Outcomes of re-excision after unplanned excisions of soft-tissue sarcomas.
OBJECTIVE
Unplanned excisions of soft-tissue sarcomas of the extremities occur commonly. Our goal was to evaluate the presence of residual disease, the treatment outcomes as they relate to local and distant recurrence and 5-year survival, and the limb functional outcomes in patients with unplanned sarcoma excision who were treated with re-excision and adjuvant therapy.


METHODS
Between 1993 and 1999, 42 patients presented to our institution after unplanned excision of soft-tissue sarcomas. Of those 42 patients, 38 without gross residual disease or metastatic lesions formed the basis of this review. All 38 patients underwent revision wide excision; most (31) also received adjuvant therapy (radiation and/or chemotherapy). Clinical data were obtained from analysis of patient records and radiographic studies. Univariate analysis was performed with logistical regression, and multivariate analysis was performed with Cox modeling.


RESULTS
The overall 5-year survival rate was 91.3% and the disease-free 5-year survival rate was 82.2%. Univariate analysis showed that stage-III disease (American Joint Committee on Cancer classification of soft-tissue sarcomas), lesions below the fascia, a histologic high-grade, and the development of organ metastasis were statistically significant factors for mortality. Stage-III disease also was significant for mortality on multivariate analysis. Only stage-III disease was significant for the development of local recurrence. Eighty-four percent of the patients had good to excellent functional outcomes.


CONCLUSIONS
Re-excision with adjuvant therapy proved to be a safe and effective method for treating the disease and preserving limb function.
Manoso
Mark W
MW
Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD 21224, USA.
Frassica
Deborah A
DA
Deune
E Gene
EG
Frassica
Frank J
FJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000601:surgery*; D018365:Neoplasm, Residual / Q000453:epidemiology / Q000601:surgery*; D016016:Proportional Hazards Models; D012086:Reoperation; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome