Does delayed reexcision affect outcome after unplanned excision for soft tissue sarcoma?
BACKGROUND
Unplanned excision of a soft tissue sarcoma generally requires reexcision to achieve an adequate surgical margin. Many surgeons assume delay of definitive surgery adversely affects patient survival and local recurrence. However, no clear evidence of this assumption can be found in the literature.


OBJECTIVE
We asked whether delay in reexcision affects patient survival and local recurrence in reexcision after unplanned excision for soft tissue sarcoma.


METHODS
We retrospectively reviewed 104 patients who underwent definitive surgery after unplanned excision of a localized soft tissue sarcoma. The average age of the patients was 44 years (range, 5-81 years). The most common diagnoses were malignant fibrous histiocytoma (36) and synovial sarcoma (22). Locations of the tumors were the lower extremity (62), upper extremity (32), and trunk (10). The median interval to definitive surgery was 32 days (interquartile range, 22-50 days). The minimum followup was 0.2 years (median, 4.7 years; range, 0.2-16.7 years).


RESULTS
The 5-year disease-specific survival was 88% and 5-year local control rate was 74%. We found no difference in disease-specific survival or local recurrence according to the time until definitive surgery. Higher histologic grade and larger tumor size independently predicted disease-specific survival whereas a positive margin at reexcision and larger tumor size independently predicted local control.


CONCLUSIONS
The data suggest any influence of delayed definitive surgery is likely to be of minor clinical importance.


METHODS
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 110-744, Korea.
Ilkyu
I
Han
Hyun Guy
HG
Kang
Seung Chul
SC
Kang
Jay Rim
JR
Choi
Han-Soo
HS
Kim
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D018219:Histiocytoma, Benign Fibrous / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D013584:Sarcoma, Synovial / Q000401:mortality / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult