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Connective Tissue Oncology Society |
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| 2001 CTOS Annual Meeting Posters— Medical Oncology THE IMMEDIATE RE-EXCISION
OF SOFT TISSUE SARCOMAS AFTER INADEQUATE INITIAL SURGERY OBJECTIVE: Soft tissue sarcoma (STS), a rare tumor entity, is often mistreated by local excision because of their supposed benignity. This results in local recurrence-rates up to 70%. Since 1988 we perform a re-excision in patients where initial resection was made not achieving wide margins. Most patients were referred for assumed adjuvant therapy, but interdisciplinary evaluation of patients and charts revealed initial close resection margins. METHODS: From 1988 until 1998 287 patients were treated in our department suffering from primary soft tissue sarcomas of the extremities or of the trunk. 115 patients were treated before with simple excision not achieving adequate margins. These patients were re-resected in-between the next 9 to 37 days after primary resection. RESULTS: 67 male and 48 female patients with a mean age of 47 years were included into this study. The STS were located either at the extremities (lower extremity: n=67, upper extremity: n=26) or at the trunk (n=22). 62 of them were subcutaneous, 53 subfascial. The histological grade was in n=45 cases G1, in n=40 G2 and in n=30 G3. All of the subcutaneous and 33 subfascial STS were treated locally by wide resection, 20 of the latter received a compartmental resection. In 102 patients a R0-resection was achieved, 13 resection R1 patients - refused further surgery, resulting in amputation. In 53 cases (46%) the histology revealed residual tumor: 14 of them multifocally and in 50 specimen tumor was detected macroscopically. Adjuvant therapy was administered in 33 patients and chemotherapy in 12 patients. Local recurrence occurred in 15 patients (13%). After a mean follow-up of 69 (17-121) months, 87 patients were alive without evidence of disease, and 7 were alive with tumors. 8 patients died tumor-related, 6 died of other reasons. CONCLUSION: In case of inadequate initial surgery the primary re-excision should have highest priority in the multimodality treatment concept, since nearly 50% showed a residual tumor though were reported for being excised completely. The resection with wide margins plays the key role for soft tissue sarcoma therapy leading to a smaller rate of recurrence and assumingly less distant metastasis.
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