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Benefit of surgical resection of distant metastasis in soft tissue sarcoma: a systematic review
Katsuhiro Hayashi1, Koji Hiraoka2, Toru Akiyama3
1Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Objective:
The aim of this systematic review was to evaluate the efficacy of metastasectomy for patients with advanced soft tissue sarcoma and to develop a recommendation outlining clinical guidelines for soft tissue sarcoma.
Methods:
We searched the pertinent literature from January 1985 to December 2017. Two reviewers evaluated and screened the literature independently for eligibility and extracted data. We evaluated the quality of body of evidence and made a recommendation according to the Grading of Recommendations Development and Evaluation methodology.
Results:
Among 244 identified studies, only 10 were finally included in this review and no randomized controlled trial reports were present. The median survival period after metastasectomy ranged from 9.6 to 39.6 months, and the 5-year survival rate ranged from 8 to 52%. The complication rate ranged from 7.3 to 25%, and the perioperative mortality rate was 0-1%. The guidelines committee proposed 'Metastasectomy can be offered for malignant soft tissue tumours with distant metastases'. This recommendation gained 100% consensus among the members of the guidelines group.
Conclusions:
Although the level of evidence is very low, many retrospective studies support a clinical advantage for metastasectomy, and surgical indications should be carefully considered for patients with metastasis from soft tissue sarcoma. Metastasectomy is an option for patients with metastasis and should be done only if it can be performed safely and if potential advantages outweigh disadvantages.
Insights
Metastasectomy may offer a clinical advantage for patients with advanced soft tissue sarcoma, despite low evidence levels. Careful consideration of surgical risks versus benefits is recommended for this metastasis treatment.
Area of Science:
- Oncology
- Surgical Oncology
- Sarcoma Research
Background:
- Advanced soft tissue sarcoma often presents with distant metastases, posing treatment challenges.
- Metastasectomy, the surgical removal of metastatic tumors, is a potential treatment modality.
- Clinical guidelines for the management of metastatic soft tissue sarcoma are needed.
Purpose of the Study:
- To systematically review the efficacy of metastasectomy in patients with advanced soft tissue sarcoma.
- To develop clinical guidelines for soft tissue sarcoma management based on available evidence.
Main Methods:
- A systematic literature search was conducted from January 1985 to December 2017.
- Two independent reviewers screened studies for eligibility and extracted data.
- Evidence quality was assessed using the Grading of Recommendations Development and Evaluation (GRADE) methodology.
Main Results:
- Ten studies were included from 244 identified; no randomized controlled trials were found.
- Median survival post-metastasectomy ranged from 9.6 to 39.6 months; 5-year survival rates were 8-52%.
- Complication rates were 7.3-25%, with a 0-1% perioperative mortality rate.
Conclusions:
- Retrospective studies suggest a clinical benefit of metastasectomy for soft tissue sarcoma metastasis.
- Metastasectomy is a viable option if performed safely and benefits outweigh risks.
- The recommendation is that metastasectomy can be offered for malignant soft tissue tumors with distant metastases.
