title: Inadvertent surgical resection of soft tissue sarcomas.
abstract: BACKGROUND
  The National Institute of Clinical Excellence (NICE) published Improving Outcome Guidance in 2006 defining urgent referral criteria for soft tissue sarcoma (STSs) with the twin aims of improving diagnostic accuracy and overall outcome. Despite these guidelines inadvertent excisions of soft tissue sarcomas continue to occur with alarming frequency, potentially compromising patient outcomes.
  
  
  OBJECTIVE
  We reviewed the East Midlands Sarcoma Service experience of treating inadvertent excision of STSs and highlight the patient profile, referral pattern, subsequent management and oncological outcome associated with inadvertent resection.
  
  
  METHODS
  Patients were identified from our sarcoma database and a retrospective case note review performed.
  
  
  RESULTS
  Over a 3-year period, 42 patients presented to our specialist centre after unplanned excision of soft tissue sarcomas. There were 29 men and 13 women, with a mean age at presentation of 59 years (19-90). 50% of the tumours were located in lower extremity, 33% around the trunk and 17% in the upper extremity. The unplanned surgery was most commonly from general surgeons, plastic surgeons, orthopaedic surgeons, general practitioners followed by vascular surgeons. Re-resection was undertaken in 40 cases to achieve clear margins with residual tumour present in 74% of cases. Limb salvage surgery was not possible in 5 cases.
  
  
  CONCLUSIONS
  Unplanned excision of sarcoma by non-oncologic surgeons remains a problem. It appears that it is equally prevalent in varied surgical community and general practitioners. Excision of large or deep solid soft tissue masses without tissue diagnosis is unacceptable.
authors.affiliation: Department of Orthopaedics, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK. s.m.robinson@ncl.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Venkatesan
authors.forename: C J
authors.initials: CJ
authors.lastname: Richards
authors.forename: T A
authors.initials: TA
authors.lastname: McCulloch
authors.forename: A G B
authors.initials: AG
authors.lastname: Perks
authors.forename: A
authors.initials: A
authors.lastname: Raurell
authors.forename: R U
authors.initials: RU
authors.lastname: Ashford
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D016208:Databases, Factual; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis* / Q000601:surgery*; D013222:State Medicine / Q000592:standards; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D055815:Young Adult