title: Unplanned resection of a soft tissue sarcoma: clinical characteristics and impact on oncological and functional outcomes.
abstract: BACKGROUND
  Over the past three decades, several studies have reported worse outcomes with unplanned resection for malignant soft tissue tumors. However, the impact of these studies on preventing unnecessary unplanned resection remains unknown.
  
  
  METHODS
  In a retrospective survey on the treatment of soft tissue sarcomas, we compared cases of unplanned resection with cases of planned resection in terms of the properties of unplanned resection and the oncological and functional outcomes. For the unplanned resection cases, an additional wide resection was performed.
  
  
  RESULTS
  Of 92 cases, unplanned resection was performed in 24 (26 %). Small or subcutaneous tumors were significantly more frequently subjected to unplanned resection. In 17 of 24 unplanned resection cases, residual tumors (70.8 %) were noted. Plastic surgery was more frequently needed for unplanned resection cases. There was no significant difference between the unplanned resection and control cases with regard to oncological outcome. However, as to local recurrence and overall survival, the events occurred only in the cases with residual tumors in the additional wide resection specimen in the unplanned resection group. There was no significant difference in functional evaluation, except for emotional acceptance, which had a better score in the unplanned resection group.
  
  
  CONCLUSIONS
  Despite repeated cautions regarding unplanned resection in terms of its inadequate procedure which contradicts the principles of soft tissue sarcoma treatment, unplanned resections are still frequently performed. Perhaps the small size and subcutaneous location of the sarcomas in the unplanned resection group did not evoke the probability of malignancy for the surgeons who initially managed them. Even though an additional wide resection was performed, a residual tumor would lead to a worse outcome. An effective awareness program to avoid unnecessary unplanned resections for soft tissue sarcoma should be considered.
authors.affiliation: Department of Orthopedic Surgery, Kyorin University, 6-20-2 Shinwaka, Mitaka, Tokyo, 161-8611, Japan, t-morii@gb3.so-net.ne.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morii
authors.forename: Takayuki
authors.initials: T
authors.lastname: Aoyagi
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajima
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshiyama
authors.forename: Shouichi
authors.initials: S
authors.lastname: Ichimura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Mochizuki
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome