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Prognostic Effect of Re-Excision in Adult Soft Tissue Sarcoma of the Extremity

¹ Department of Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, 20133, Milan, Italy
² Department of Medical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, 20133, Milan, Italy
³ Department of Biostatistics, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, 20133, Milan, Italy
⁴ Department of Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, 20133, Milan, Italy
⁵ Department of Pathology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, 20133, Milan, Italy

Correspondence: Address correspondence and reprint requests to: Alessandro Gronchi, MD; E-mail: alessandro.gronchi{at}istitutotumori.mi.it.

Background: We explored the outcome of patients with primary adult soft tissue sarcoma (STS) of the extremities undergoing re-excision after previous unplanned surgery.

Methods: A total of 597 consecutive adult patients with primary extremity STS were treated with conservative surgery at our institution over a 20-year time span. A total of 318 patients were referred after unplanned excisions, and the remaining 279 underwent primary resection at our center. The two groups significantly differed in tumor size and depth. The assessed end points were sarcoma-specific mortality, local recurrence, and distant metastasis. Univariable and multivariable analyses, adjusted for other prognostic factors, were performed in the competing risks framework.

Results: The adjusted 10-year cumulative incidences in re-excised and primarily operated patients were, respectively, 18.7% and 16.4% (P = .535) for local relapse, 17.6% and 20.2% (P = .541) for metastasis, and 20.4% and 22.4% (P = .645) for mortality. Among patients who underwent re-excision, evidence of microscopic residual disease on pathologic examination had a significant prognostic effect on multivariable analysis for distant metastases (P = .002). A trend for survival was detected as well.

Conclusions: At a referral center with a liberal policy of re-excisions in adult primary STS of the extremities, the outcome of patients who underwent re-excision was similar to that of patients who had primary resections. Evidence of microscopic residual disease at re-excision was a marker of clinical aggressiveness.

Key Words: Soft tissue sarcoma • Limbs • Surgery • Re-excision • Prognosis

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