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

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Abstract

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.

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Authors and Affiliations

  1. Department of Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, Milan, 20133, Italy

    Marco Fiore MD, Chiara Mussi MD & Alessandro Gronchi MD

  2. Department of Medical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, Milan, 20133, Italy

    Paolo G. Casali MD & Rossella Bertulli MD

  3. Department of Biostatistics, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, Milan, 20133, Italy

    Rosalba Miceli PhD & Luigi Mariani MD

  4. Department of Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, Milan, 20133, Italy

    Laura Lozza MD & Patrizia Olmi MD

  5. Department of Pathology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, Milan, 20133, Italy

    Paola Collini MD

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  1. Marco Fiore MD
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  2. Paolo G. Casali MD
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  3. Rosalba Miceli PhD
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  4. Luigi Mariani MD
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  6. Laura Lozza MD
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  9. Chiara Mussi MD
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  10. Alessandro Gronchi MD
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Correspondence to Alessandro Gronchi MD.

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Fiore, M., Casali, P.G., Miceli, R. et al. Prognostic Effect of Re-Excision in Adult Soft Tissue Sarcoma of the Extremity. Ann Surg Oncol 13, 110–117 (2006). https://doi.org/10.1245/ASO.2006.03.030

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  • DOI: https://doi.org/10.1245/ASO.2006.03.030

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