Posters— Surgical Treatment of Sarcomas

COMPLICATIONS AND MORBIDITY OF ADJUVANT THERAPY FOR SOFT TISSUE SARCOMA

Templeton KT, (University of Kansas Medical Center, Kansas City, Kansas)

Although adjuvant therapy, combined with surgery, can lead to local tumor control and salvage of extremity, post-operative complications can delay further treatment and, potentially, lead to loss of the extremity. This study was designed to analyze those factors that may contribute to post-operative morbidity.

Methods: The records of 45 patients presenting with extremity soft tissue sarcomas were reviewed retrospectively. Five patients were unable to undergo limb salvage, leaving forty patients that form the basis of this study. These patients all underwent surgical resection of their tumors in combination with radiation (pre-or post-operatively) and/or chemotherapy. They were then followed for at least three months to evaluate for post-operative complications. The complications were defined as major (i.e., requiring further surgery) or minor (managed non-operatively).

Results: There were 24 female and 16 male patients with an average age of 55 years. The most common diagnoses were MFH and liposarcoma. The most common locations for the tumor were thigh and forearm. 31 patients received radiotherapy, 21 pre-operatively (6 with a post-operative boost) and 10 post-operatively only. There were 4 minor complications, usually slough of a skin graft, and 16 major complications. The most frequent major complications were seromas, primarily in those patients treated initially with a free tissue transfer into the resection bed, and dehiscence, seen in those patients closed primarily. 2 free tissue transfers underwent necrosis, presumably due to the anastomoses being performed into abnormally large vessels adjacent to the tumor, which eventually decreased in caliber. No complication resulted in an amputation. Patient factors that were analyzed and found not to be related to major wound complications were age, gender, obesity (measured by body mass index), nutrition (measured by white cell count and serum albumin), and smoking. Treatment factors that were not related to complications were the use of chemotherapy, radiation dose, and interval between pre-op radiation and surgery. However, those receiving pre-op radiation had significantly more complications than those treated with post-op RT alone. Further, those with a larger estimated volume of resection, especially if treated with pre-op RT, had a higher incidence of complications. Other surgical factors that correlated with wound complications were the width of resection (most likely affecting the vascularity of the operative bed), estimated volume of resection (although modified if free tissue transfer was performed), and estimated blood loss. Total operative time was not significant. Another independent risk factor for complications was an incisional or excisional biopsy performed at another institution prior to presentation (56% complications versus 29%). This was not due to increased resection volume as the volume of tissue ultimately resected was lower (944.7cm3 vs. 1888 cm3) for those initially treated elsewhere.

Conclusions: Post-operative morbidity appears to be relatively independent of the patient factors analyzed herein. Morbidity is more likely to be determined by treatment and tumor-related factors, such as tumor and therefore, resection volume and width, estimated blood loss, and prior surgery. These factors may lead to relative hypoxia in the resection bed.