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Erschienen in:

09.11.2021 | Sarcoma

Assessing the Safety and Utility of Wound VAC Temporization of the Sarcoma or Benign Aggressive Tumor Bed Until Final Margins Are Achieved

verfasst von: Mitchell S. Fourman, MD, MPhil, Duncan C. Ramsey, MD, MPH, Erik T. Newman, MD, Joseph H. Schwab, MD, MS, Yen-Lin Chen, MD, Yin P. Hung, MD, Ivan Chebib, MD, Vikram Deshpande, MD, MBBS, G. Petur Nielsen, MD, Thomas F. DeLaney, MD, John T. Mullen, MD, Kevin A. Raskin, MD, Santiago A. Lozano Calderón, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 4/2022

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Abstract

Background

Local recurrence of microinvasive sarcoma or benign aggressive pathologies can be limb- and life-threatening. Although frozen pathology is reliable, tumor microinvasion can be subtle or missed, having an impact on surgical margins and postoperative radiation planning. The authors’ service has begun to temporize the tumor bed after primary tumor excision with a wound vacuum-assisted closure (VAC) pending formal margin analysis, with coverage performed in the setting of final negative margins.

Methods

This retrospective analysis included all patients managed at a tertiary referral cancer center with VAC temporization after soft tissue sarcoma or benign aggressive tumor excision from 1 January 2000 to 1 January 2019 and at least 2 years of oncologic follow-up evaluation. The primary outcome was local recurrence. The secondary outcomes were distant recurrence, unplanned return to the operating room for wound/infectious indications, thromboembolic events, and tumor-related deaths.

Results

For 62 patients, VAC temporization was performed. The mean age of the patients was 62.2 ± 22.3 years (median 66.5 years; 95% confidence interval [CI] 61.7–72.5 years), and the mean age-adjusted Charlson Comorbidity Index was 5.3 ± 1.9. The most common tumor histology was myxofibrosarcoma (51.6%, 32/62). The mean volume was 124.8 ± 324.1 cm3, and 35.5% (22/62) of the cases were subfascial. Local recurrences occurred for 8.1% (5/62) of the patients. Three of these five patients had planned positive margins, and 17.7% (11/62) of the patients had an unplanned return to the operating room. No demographic or tumor factors were associated with unplanned surgery.

Conclusions

The findings showed that VAC-temporized management of microinvasive sarcoma and benign aggressive pathologies yields favorable local recurrence and unplanned operating room rates suggestive of oncologic and technical safety. These findings will need validation in a future randomized controlled trial.
Literatur
1.
Zurück zum Zitat Trovik CS, Gustafson P, Bauer HCF, et al. Consequences of local recurrence of soft tissue sarcoma: 205 patients from the Scandinavian Sarcoma Group register. Acta Orthop Scand. 2000;71:488–95.CrossRef Trovik CS, Gustafson P, Bauer HCF, et al. Consequences of local recurrence of soft tissue sarcoma: 205 patients from the Scandinavian Sarcoma Group register. Acta Orthop Scand. 2000;71:488–95.CrossRef
2.
Zurück zum Zitat Sugiura H, Tsukushi S, Yoshida M, et al. What is the success of repeat surgical treatment of a local recurrence after initial wide resection of soft tissue sarcomas? Clin Orthop Relat Res. 2018;476:1791–800.CrossRef Sugiura H, Tsukushi S, Yoshida M, et al. What is the success of repeat surgical treatment of a local recurrence after initial wide resection of soft tissue sarcomas? Clin Orthop Relat Res. 2018;476:1791–800.CrossRef
3.
Zurück zum Zitat Zagars GK, Ballo MT, Pisters PWT, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer. 2003;97:2530–43.CrossRef Zagars GK, Ballo MT, Pisters PWT, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer. 2003;97:2530–43.CrossRef
4.
Zurück zum Zitat Choy E. Sarcoma after 5 years of progression-free survival: lessons from the French Sarcoma Group. Cancer. 2014;120:2942–3.CrossRef Choy E. Sarcoma after 5 years of progression-free survival: lessons from the French Sarcoma Group. Cancer. 2014;120:2942–3.CrossRef
5.
Zurück zum Zitat Golouh R, Bracko M. Accuracy of frozen section diagnosis in soft tissue tumors. Mod Pathol. 1990;3:729–33.PubMed Golouh R, Bracko M. Accuracy of frozen section diagnosis in soft tissue tumors. Mod Pathol. 1990;3:729–33.PubMed
6.
Zurück zum Zitat Ma Z, Shou K, Li Z, et al. Negative-pressure wound therapy promotes vessel destabilization and maturation at various stages of wound healing and thus influences wound prognosis. Exp Ther Med. 2016;11:1307–17.CrossRef Ma Z, Shou K, Li Z, et al. Negative-pressure wound therapy promotes vessel destabilization and maturation at various stages of wound healing and thus influences wound prognosis. Exp Ther Med. 2016;11:1307–17.CrossRef
8.
Zurück zum Zitat Kopp J, Strnad V, Bach AD, et al. Vacuum application increases therapeutic safety and allows intensified local radiation treatment of malignant soft-tissue tumors. Strahlentherapie und Onkol. 2005;181:124–30.CrossRef Kopp J, Strnad V, Bach AD, et al. Vacuum application increases therapeutic safety and allows intensified local radiation treatment of malignant soft-tissue tumors. Strahlentherapie und Onkol. 2005;181:124–30.CrossRef
9.
Zurück zum Zitat Naghavi AO, Gonzalez RJ, Scott JG, et al. Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma. J Contemp Brachyther. 2017;9:20–9.CrossRef Naghavi AO, Gonzalez RJ, Scott JG, et al. Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma. J Contemp Brachyther. 2017;9:20–9.CrossRef
10.
Zurück zum Zitat Lawrenz JM, Mesko NW, Marshall DC, et al. Immediate versus staged soft tissue reconstruction after soft tissue sarcoma resection has similar wound and oncologic outcomes. Ann Plast Surg. 2020;85:163–70.CrossRef Lawrenz JM, Mesko NW, Marshall DC, et al. Immediate versus staged soft tissue reconstruction after soft tissue sarcoma resection has similar wound and oncologic outcomes. Ann Plast Surg. 2020;85:163–70.CrossRef
11.
Zurück zum Zitat Naghavi AO, Gonzalez RJ, Scott JG, et al. Implications of staged reconstruction and adjuvant brachytherapy in the treatment of recurrent soft tissue sarcoma. Brachytherapy. 2016;15:495–503.CrossRef Naghavi AO, Gonzalez RJ, Scott JG, et al. Implications of staged reconstruction and adjuvant brachytherapy in the treatment of recurrent soft tissue sarcoma. Brachytherapy. 2016;15:495–503.CrossRef
12.
Zurück zum Zitat Dougherty PJ, Andreatta P. CORR curriculum—orthopaedic education: competency-based medical education—how do we get there? Clin Orthop Relat Res. 2017;475:1557–60.CrossRef Dougherty PJ, Andreatta P. CORR curriculum—orthopaedic education: competency-based medical education—how do we get there? Clin Orthop Relat Res. 2017;475:1557–60.CrossRef
13.
Zurück zum Zitat Chen Y, Xu SF, Xu M, et al. Use of negative-pressure wound therapy as an adjunct to the treatment of extremity soft-tissue sarcoma with ulceration or impending ulceration. Oncol Lett. 2016;12:757–63.CrossRef Chen Y, Xu SF, Xu M, et al. Use of negative-pressure wound therapy as an adjunct to the treatment of extremity soft-tissue sarcoma with ulceration or impending ulceration. Oncol Lett. 2016;12:757–63.CrossRef
14.
Zurück zum Zitat Siegel GW, Kuzon WM, Hasen JM, et al. Staged soft tissue reconstruction following sarcoma excision with anticipated large cutaneous defects: an oncologically safe alternative. Iowa Orthop J. 2016;36:104.PubMedPubMedCentral Siegel GW, Kuzon WM, Hasen JM, et al. Staged soft tissue reconstruction following sarcoma excision with anticipated large cutaneous defects: an oncologically safe alternative. Iowa Orthop J. 2016;36:104.PubMedPubMedCentral
15.
Zurück zum Zitat Nakamura T, Grimer R, Gaston C, et al. The value of C-reactive protein and comorbidity in predicting survival of patients with high-grade soft tissue sarcoma. Eur J Cancer. 2013;49:377–85.CrossRef Nakamura T, Grimer R, Gaston C, et al. The value of C-reactive protein and comorbidity in predicting survival of patients with high-grade soft tissue sarcoma. Eur J Cancer. 2013;49:377–85.CrossRef
16.
Zurück zum Zitat Slump J, Bastiaannet E, Halka A, et al. Risk factors for postoperative wound complications after extremity soft tissue sarcoma resection: a systematic review and meta-analyses. J Plast Reconstr Aesthet Surg. 2019;72:1449–64.CrossRef Slump J, Bastiaannet E, Halka A, et al. Risk factors for postoperative wound complications after extremity soft tissue sarcoma resection: a systematic review and meta-analyses. J Plast Reconstr Aesthet Surg. 2019;72:1449–64.CrossRef
17.
Zurück zum Zitat Traub F, Griffin AM, Wunder JS, et al. Influence of unplanned excisions on the outcomes of patients with stage III extremity soft-tissue sarcoma. Cancer. 2018;124:3868–75.CrossRef Traub F, Griffin AM, Wunder JS, et al. Influence of unplanned excisions on the outcomes of patients with stage III extremity soft-tissue sarcoma. Cancer. 2018;124:3868–75.CrossRef
18.
Zurück zum Zitat Bianchi G, Sambri A, Cammelli S, et al. Impact of residual disease after “unplanned excision” of primary localized adult soft tissue sarcoma of the extremities: evaluation of 452 cases at a single institution. Musculoskelet Surg. 2017;101:243–8.CrossRef Bianchi G, Sambri A, Cammelli S, et al. Impact of residual disease after “unplanned excision” of primary localized adult soft tissue sarcoma of the extremities: evaluation of 452 cases at a single institution. Musculoskelet Surg. 2017;101:243–8.CrossRef
19.
Zurück zum Zitat Odei B, Rwigema JC, Eilber FR, et al. Predictors of local recurrence in patients with myxofibrosarcoma. Am J Clin Oncol Cancer Clin Trials. 2018;41:827–31. Odei B, Rwigema JC, Eilber FR, et al. Predictors of local recurrence in patients with myxofibrosarcoma. Am J Clin Oncol Cancer Clin Trials. 2018;41:827–31.
20.
Zurück zum Zitat Look Hong NJ, Hornicek FJ, Raskin KA, et al. Prognostic factors and outcomes of patients with myxofibrosarcoma. Ann Surg Oncol. 2013;20:80–6.CrossRef Look Hong NJ, Hornicek FJ, Raskin KA, et al. Prognostic factors and outcomes of patients with myxofibrosarcoma. Ann Surg Oncol. 2013;20:80–6.CrossRef
21.
Zurück zum Zitat Ghazala CG, Agni NR, Ragbir M, et al. Myxofibrosarcoma of the extremity and trunk a multidisciplinary approach leads to good local rates of local control. Bone Jt J. 2016;98-B:1682–8.CrossRef Ghazala CG, Agni NR, Ragbir M, et al. Myxofibrosarcoma of the extremity and trunk a multidisciplinary approach leads to good local rates of local control. Bone Jt J. 2016;98-B:1682–8.CrossRef
22.
Zurück zum Zitat Chen S, Huang W, Luo P, et al. Undifferentiated pleomorphic sarcoma: long-term follow-up from a large institution. Cancer Manag Res. 2019;11:10001–9.CrossRef Chen S, Huang W, Luo P, et al. Undifferentiated pleomorphic sarcoma: long-term follow-up from a large institution. Cancer Manag Res. 2019;11:10001–9.CrossRef
25.
Zurück zum Zitat Miller SJ, Alam M, Andersen JS, et al. Dermatofibrosarcoma protuberans. JNCCN J Natl Compr Cancer Netw. 2012;10:312–8.CrossRef Miller SJ, Alam M, Andersen JS, et al. Dermatofibrosarcoma protuberans. JNCCN J Natl Compr Cancer Netw. 2012;10:312–8.CrossRef
26.
Zurück zum Zitat Paradisi A, Abeni D, Rusciani A, et al. Dermatofibrosarcoma protuberans: wide local excision versus Mohs micrographic surgery. Cancer Treat Rev. 2008;34:728–36.CrossRef Paradisi A, Abeni D, Rusciani A, et al. Dermatofibrosarcoma protuberans: wide local excision versus Mohs micrographic surgery. Cancer Treat Rev. 2008;34:728–36.CrossRef
Metadaten
Titel
Assessing the Safety and Utility of Wound VAC Temporization of the Sarcoma or Benign Aggressive Tumor Bed Until Final Margins Are Achieved
verfasst von
Mitchell S. Fourman, MD, MPhil
Duncan C. Ramsey, MD, MPH
Erik T. Newman, MD
Joseph H. Schwab, MD, MS
Yen-Lin Chen, MD
Yin P. Hung, MD
Ivan Chebib, MD
Vikram Deshpande, MD, MBBS
G. Petur Nielsen, MD
Thomas F. DeLaney, MD
John T. Mullen, MD
Kevin A. Raskin, MD
Santiago A. Lozano Calderón, MD, PhD
Publikationsdatum
09.11.2021
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 4/2022
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-021-11023-9

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