title: Outcomes of unplanned sarcoma excision: impact of residual disease.
abstract: This study aimed to compare the oncological results between unplanned excision (UE) and planned excision (PE) of malignant soft tissue tumor and to examine the impact of residual tumor (ReT) after UE. Nonmetastatic soft tissue sarcomas surgically treated in 1996-2012 were included in this study. Disease-specific survival (DSS), metastasis-free survival (MFS), and local-recurrence-free survival (LRFS) were stratified according to the tumor location and American Joint Committee on Cancer Classification 7th edition stage. Independent prognostic parameters were identified by Cox proportional hazard models. Two-hundred and ninety PEs and 161 UEs were identified. Significant difference in oncological outcome was observed only for LRFS probability of retroperitoneal sarcomas (5-year LRFS: 33.0% [UE] vs. 71.0% [PE], P = 0.018). Among the 142 UEs of extremity and trunk, ReT in re-excision specimen were found in 75 cases (53%). UEs with ReT had significantly lower survival probabilities and a higher amputation rate than UEs without ReT (5-year DSS: 68.8% vs. 92%, P < 0.001; MFS: 56.1% vs. 90.9%, P < 0.001; LRFS: 75.8% vs. 98.4%, P = <0.001; amputation rate 18.5% vs. 1.8%, P = 0.003). The presence of ReT was an independent poor prognostic predictor for DSS, MFS, and LRFS with hazard ratios of 2.02 (95% confidence interval (CI), 1.25-3.26), 1.62 (95% CI, 1.05-2.51) and 1.94 (95% CI, 1.05-3.59), respectively. Soft tissue sarcomas should be treated in specialized centers and UE should be avoided because of its detrimental effect especially when ReT remains after UE.
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia.|Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok 10400, Thiland, Thailand.
authors.forename: Chris
authors.identifier: http://orcid.org/0000-0002-4682-9856
authors.initials: C
authors.lastname: Charoenlap
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia.
authors.forename: Jungo
authors.initials: J
authors.lastname: Imanishi
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Pathology, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy 3065, Victoria, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Slavin
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne 3002, Victoria, Australia.|Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne 3002, Victoria, Australia.
authors.forename: Samuel Y
authors.initials: SY
authors.lastname: Ngan
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne 3002, Victoria, Australia.|Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne 3002, Victoria, Australia.
authors.forename: Sarat
authors.initials: S
authors.lastname: Chander
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia.|Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy 3065, Victoria, Australia.
authors.forename: Michelle Maree
authors.initials: MM
authors.lastname: Dowsey
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia.
authors.forename: Chatar
authors.initials: C
authors.lastname: Goyal
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia.|Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne 3002, Victoria, Australia.|Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy 3065, Victoria, Australia.
authors.forename: Peter F M
authors.initials: PF
authors.lastname: Choong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology; D063868:Patient Outcome Assessment; D011379:Prognosis; D016016:Proportional Hazards Models; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Neoplasm staging; prognosis; residual neoplasm; sarcoma mortality; sarcoma surgery; soft tissue sarcoma; treatment outcome