Unplanned surgical excision of extremity soft tissue sarcomas: patient profile and referral patterns

Unplanned surgical excision of sarcomas remains a major treatment dilemma in the control of local disease. The purpose of this study is to develop a patient profile to identify patients at high risk for an unplanned excision. The study group consisted of 54 patients following an unplanned excision of a soft tissue sarcoma. The characteristics that were identified as high risk included the following: 20- to 40-year age range,>5 cm, trauma, and deep to fascia. It was common for the interpretation of imaging studies not to mention the possibility of sarcoma in the differential diagnosis. Patient referral was most commonly from general surgeons without specialty training in oncology. Orthopaedic surgeons should not rely solely on the radiologist's interpretation because they often lack clinical information necessary to direct them toward the diagnosis of sarcoma. This is particularly important in patients who are at high risk for unplanned excision as identified in this study. Unplanned excisions by nononcologic surgeons remain a problem; however, it appears that it is more prevalent in the general surgical community than in orthopaedics. This may be as a result of studies addressing this issue in orthopaedic journals, with emphasis of these articles at teaching institutions.