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Reconstructing Soft Tissue Sarcoma Patients: Tumor Bed Excision Defects Are Deceiving and Result in Higher Reoperation Rates
Rami Elmorsi, MD, Luis Camacho, MD, David D Krijgh, MD, Gordon S Tilney, PA-C, Heather Lyu, MD, MBI, Raymond S Traweek, MD, Russel G Witt, MD, MAS, MS, Margaret S Roubaud, MD, Arlene Correa, PhD, Christina L Roland, MD, MD, Alexander F Mericli, MD
MD Anderson Cancer Centre, Houston, TX, USA
PURPOSE: Soft Tissue Sarcomas (STS) may be misdiagnosed and/or inadequately resected, leaving behind microscopic disease that necessitates a secondary Tumor Bed Excision (TBE). Little is known about these patients’ course and outcomes given the rarity of centers treating them.
METHODS: We retrospectively analyzed reconstructed cases from 2016 to 2021, comparing TBE to mass excisions (ME). Demographics, oncological variables, reconstructive techniques, and outcomes were included. Parametric and non-parametric comparisons were employed as appropriate.
RESULTS: In contrast to STS ME, TBE patients were mostly females, had shorter hospital stays, longer follow-up periods, and more plastic surgery involvement (p<0.05). The two groups differed significantly in sarcoma locations, pathologies, and defect dimensions, with TBE being smaller than ME (p<0.05). TBE had significantly greater rates of reoperation (16% vs. 8.5%; p=0.03) and graft loss (38.9% vs. 15.6%; p<0.001), but overall complications were similar between the groups (39.6% vs. 31.3%; p=0.13). Tables 1 and 2 are univariate analyses for complications in both groups.
CONCLUSION: Although TBE defects are significantly smaller, they have a greater reoperation rate. While both TBE and ME defects stem from STS excisions, they seem to differ clinically from a wound-healing perspective. Plastic Surgeons should consider advanced reconstructive options, especially for TBE defects.
Univariate Analysis for Overall Complications in Tumor Bed Excision Defects Reconstruction (n=106). | OR (95% CI) | p |
| Male | 2.3 (1.05-5.1) | 0.03 |
| Medial Thigh | 5.7 (1.7-19.2) | 0.002 |
| Local Flap | 3.5 (1.1-11.2) | 0.03 |
| Full Thickness Skin Graft | 3.5 (1.1-11.2) | 0.03 |
| Pedicled Flap | 0.3 (0.12-0.89) | 0.02 |
| Free Flap | 0.2 (0.06-0.89) | 0.02 |
| Neoadjuvant Chemotherapy | 0.08 (0.01-0.66) | 0.004 |
Univariate Analysis for Overall Complications in Mass Excision Defects Reconstruction | 95% CI | p |
| Tumor Thickness | 1.07 (1-1.11) | 0.005 |
| Medial Thigh | 2.6 (1.4-4.7) | 0.002 |
| Complex Repair | 2.8 (1.6-4.9) | 0.001 |
| Free Flap | 0.38 (0.15-0.96) | 0.03 |
| Hypertension | 1.8 (1.1-3.1) | 0.02 |
| Preoperative Radiotherapy | 2.7 (1.3-5.7) | 0.005 |
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