Posters— Surgical Treatment of Sarcomas

SOFT-TISSUE SARCOMA (STS)- ADHERENCE TO GUIDELINES

P.H.A. Nijhuis^*1, M. Schaapveld^*2, R. Otter^*2, H.J. Hoekstra^*1 (1. Dept. of Surgical Oncology, Groningen University Hospital, Groningen, The Netherlands, and 2. Comprehensive Cancer Center North-netherlands, Groningen, The Netherlands)

Introduction: Because many general surgeons are unfamiliar with these rare tumors, a reasonable number is found by chance, often after inadequate resection, leading to complex definitive treatment. Therefore, guidelines for diagnosis and treatment were developed. As the diagnostic management is essential for definitive treatment, adherence to these guidelines is important.

Methods: Primary STS, registered by the Comprehensive Cancer Center North-Netherlands from Januari 1989- Januari 1996, were analyzed retrospectively with regard to adherence to the diagnostic guidelines. Urogenital STS, gastro-intestinal STS, and Kaposi’s sarcomas were excluded.

Results: 351 STS were analyzed. In the specialized center, 69% of patients were younger than 60 years, whereas, in district hospitals, 63% were older than 60 years. With increase of age, referral to the center declined in a linear fashion. For all guidelines, adherence was significantly better in the center (see Table).

Conclusions: In many aspects of the diagnostic process of STS, existing guidelines were not followed, especially in community hospitals. Adherence to all individual guidelines was significantly better in the specialized center. In order to improve compliance with future STS-guidelines, appropriate guideline development, dissemination, and implementation programs should be developed. Concentration of STS in a limited number of hospitals, and intensified collaboration with specialized centers seem advisable. Special attention should be paid to older patients, which were significantly more often not referred to a specialized center.