Soft tissue sarcoma of the hand: Is unplanned excision a problem?

Area of Science:

• Orthopedic Oncology
• Surgical Oncology
• Hand Surgery

Background:

• Soft tissue sarcomas (STS) of the hand frequently undergo unplanned excisions, negatively impacting oncologic outcomes.
• Comparing initial treatment at oncology centers versus non-oncology centers is crucial for understanding STS management.
• Identifying factors associated with oncologic outcomes in hand STS is essential for improving patient care.

Purpose of the Study:

• To compare oncologic outcomes of hand STS initially treated at oncology centers versus non-oncology centers.
• To evaluate factors influencing oncologic outcomes in patients with hand STS.
• To assess the impact of initial treatment location on surgical management and survival rates.

Main Methods:

• Retrospective identification of adult patients with non-metastatic STS of the hand using ICD-9 codes and an institutional oncologic database.
• Inclusion of 64 patients with a median follow-up of 4.0 years.
• Analysis of patient demographics, tumor characteristics, treatment details, and oncologic outcomes.

Main Results:

• Eighty-three percent of tumors had unplanned excisions, with only one treated at an oncology center.
• Patients treated at oncology centers were older, had fewer operations, and larger tumors (median 4.7 cm vs. 3.0 cm).
• Five-year survival was 60% for oncology center treatment versus 89% for non-oncology center treatment; worse disease-free survival correlated with positive margins and subfascial tumors.

Conclusions:

• Primary treatment of hand STS at oncology centers was associated with larger tumors in older patients and worse overall survival.
• Initial treatment at non-oncology centers did not negatively impact oncologic outcomes but resulted in more re-excisions and amputations.
• Final tumor margins and tumor depth were identified as critical determinants of oncologic outcomes in hand STS.