Proffered Papers— Surgical Treatment of Sarcomas

THE EFFECT OF RE-RESECTION IN EXTREMITY SOFT TISSUE SARCOMA

Lewis JJ, Leung D, Espat J, Woodruff JM, Brennan MF
(Memorial Sloan-Kettering Cancer Center, New York, NY, 10021)

Introduction: This study was undertaken to determine if re-resection impacts on disease-specific survival in patients with inadequately resected, primary extremity soft tissue sarcoma. We analyzed two groups of patients: those who underwent a single definitive radical resection at a specialist cancer center vs those who underwent an incomplete excisional resection in the community, followed by a second definitive radical re-resection at a specialist cancer center.

Methods: Patients who underwent treatment for primary tumors (from July 1982 to June 1999) at a single institution were the subject of study. Two groups of patients were analyzed: those who underwent one definitive radical resection (one operation) and those who were previously resected and then referred for subsequent radical re-resection (two operations). Survival was determined with the Kaplan-Meier actuarial method. Statistical significance was evaluated using log-rank testing and Cox model stepwise regression.

Results: During this time we resected 1,092 patients with primary extremity soft tissue sarcoma. Of these, 685 underwent definitive radical resection and 407 underwent re-resection after undergoing excisional resection elsewhere. The median follow-up was 4.8 years. The 5-year disease-specific survival of the definitive resection (one operation) group was 68% and of the re-resection (two operations) group 84% (p=0.0001). On multivariate analysis re-resection was adjusted and controlled for age, grade, depth, size, histology and margins. Re-resection (two operations) remained a significant predictor of improved disease-specific survival (p=0.003), even after these adjustments. In order to further determine whether this difference was stage or referral biased, we divided the patient population by AJCC stage. In all stages there was a trend to improved outcome and this was most marked and statistically significant (p=0.005) for those with AJCC Stage III disease (> 5cm, high-grade and deep).

Conclusions: These data suggest that patients with extremity soft tissue sarcoma who undergo re-resection with two “primary” operations have an improved survival compared to those who undergo one operation. The most plausible explanation, referral and selection bias, is questionable given the significance of re-resection as a variable, even after adjusting for stage and other high-risk factors. This suggests that where possible, re-resection (two operations) should be liberally applied in patients with primary extremity soft tissue sarcoma.

(In press: Ann Surg) The Effect of Re-resection in Extremity Soft Tissue Sarcoma

Jonathan J. Lewis*
Denis Leung*
N. Joseph Espat*
James M. Woodruff*
Murray F. Brennan

Paper presented by Murray F. Brennan.