J Korean Orthop Assoc.  2014 Dec;49(6):431-438. 10.4055/jkoa.2014.49.6.431.

Results of Re-Excision Following Unplanned Excision of Soft Tissue Sarcoma: Comparison with the Group of Planned Excision

• Shin DS
• Choi CB
• Cho CW
• Park CH

• KMID: 2185156
• DOI: http://doi.org/10.4055/jkoa.2014.49.6.431

Abstract

PURPOSE
This study was designed to investigate the clinical and oncological results of the unplanned excision group, and to compare the results with those of the planned excision group.
MATERIALS AND METHODS
A total of 41 patients who underwent re-excision of sarcoma in Yeungnam University Medical Center, from January 2000 to December 2012, after unplanned excision in local medical centers were reviewed retrospectively. We analyzed the clinical and oncological results according to age, gender, tumor size, depth, and locations. As a control group of planned excision, 81 patients with a similar state, were selected and reviewed among the group of 480 patients who underwent planned excision during the same period. We then compared the results of the two groups.
RESULTS
In the unplanned excision group, only the age factor was statistically significant to survival (p=0.048). In comparison of clinical and oncological results of the unplanned and planned excision groups, recurrence rate was 11.1% in the unplanned group, 10.5% in the planned group and did not show statistical significance (p=0.18). Survival rate was 74% in the unplanned group, 76.6% in the planned group and did not show statistical significance (p=0.06). Necessity of additional surgery for coverage of soft tissue defects was 46% in the unplanned group, 14% in the planned group and showed statistical significance (p=0.00).
CONCLUSION
No significant difference in survival and local recurrence rate was observed between the groups of re-excision with microscopic remnant tumor after unplanned excision and planned excision. However, unplanned excision might lead to unnecessary additional surgery like skin-graft, skin-flap if it were planned.

Keyword

unplanned excision; soft tissue sarcoma

MeSH Terms

Academic Medical Centers
Age Factors
Humans
Recurrence
Retrospective Studies
Sarcoma*
Survival Rate

Figure

• 

  Figure 1 A 76-year-old male who underwent unplanned excision underwent wide re-excision and a residual tumor was confirmed via frozen biopsy. If a residual tumor was not found or the tumor was enough for a wide margin, the excision was closed. (A) Coronal view of the magnetic resonance imaging image taken after an unplanned surgical treatment. (B) Longest diameter of postoperative scar (1.5×2.0 cm). It required a wider excision than the initial scar. (C) Wide excision including the previous scar. (D, E) Propeller flap for wound closure.

• 

  Figure 2 (A) Comparison between the planned group and the unplanned group. (B) Overall and event free recurrence rate. Five-year recurrence rate was 11.1% in the unplanned group, 10.5% in the planned group. (C) Overall and event free survival rate. Five-year survival rate was 74% in the unplanned group, 76.6% in the planned group.

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