title: The effect of an unplanned excision of a soft-tissue sarcoma on prognosis.
abstract: We investigated whether our policy of routine re-excision of the tumour bed after an unplanned excision of a soft-tissue sarcoma was justified. Between April 1982 and December 2005, 2201 patients were referred to our hospital with the diagnosis of soft-tissue sarcoma, of whom 402 (18%) had undergone an unplanned excision elsewhere. A total of 363 (16.5%) were included in this study. Each patient was routinely restaged and the original histology was reviewed. Re-excision was undertaken in 316 (87%). We analysed the patient, tumour and treatment factors in relation to local control, metastasis and overall survival. Residual tumour was found in 188 patients (59%). There was thus no residual disease in 128 patients of whom 10% (13) went on to develop a local recurrence. In 149 patients (47%), the re-excision specimen contained residual tumour, but it had been widely excised. Local recurrence occurred in 30 of these patients (20%). In 39 patients (12%), residual tumour was present in a marginal resection specimen. Of these, 46% (18) developed a local recurrence. A final positive margin in a high-grade tumour had a 60% risk of local recurrence even with post-operative radiotherapy. Metastases developed in 24% (86). The overall survival was 77% at five years. Survival was related to the grade of the tumour and the finding of residual tumour at the time of re-excision. We concluded that our policy of routine re-excision after unplanned excision of soft-tissue sarcoma was justified in view of the high risk of finding residual tumour.
authors.affiliation: The Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Birmingham B31 2AP, UK.
authors.forename: C R
authors.initials: CR
authors.lastname: Chandrasekar
authors.forename: H
authors.initials: H
authors.lastname: Wafa
authors.forename: R J
authors.initials: RJ
authors.lastname: Grimer
authors.forename: S R
authors.initials: SR
authors.lastname: Carter
authors.forename: R M
authors.initials: RM
authors.lastname: Tillman
authors.forename: A
authors.initials: A
authors.lastname: Abudu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012017:Referral and Consultation / Q000592:standards*; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome