Prevention in non-oncologic intent sarcoma surgery.

Area of Science:

• Oncology
• Surgical Oncology
• Medical Imaging

Background:

• Non-oncologic resection of soft tissue sarcomas (STS) is a frequent referral to specialized centers.
• Existing literature lacks detail on surgical specialties performing these excisions and their methods.
• Understanding these patterns can inform preventative strategies for STS management.

Purpose of the Study:

• To identify surgical specialties performing unplanned STS excisions and their imaging practices.
• To determine the frequency of non-oncologic techniques in initial STS resections.
• To define indications for radiation therapy (XRT) following initial non-oncologic STS resections.

Main Methods:

• Retrospective analysis of 124 patients with STS resected non-oncologically at an outside institution.
• Data collected from 2005-2022 at a tertiary referral sarcoma center.
• Inclusion criteria: initial non-oncologic excision followed by wide re-excision of tumor bed.

Main Results:

• General Surgery (44%) and Orthopedic Surgery (28%) were the most common referring specialties for STS resection.
• General surgeons were less likely to obtain preoperative imaging (59% overall) and use tourniquets (p < 0.001).
• Residual disease post-re-excision was linked to clinic-based procedures (p=0.030) and initial stage IIIB tumors (p=0.019).

Conclusions:

• General and orthopedic surgery are primary specialties for initial non-oncologic STS resection.
• Targeted education for general surgeons on imaging and tourniquet use is recommended.
• Radiation therapy may be considered for high-grade, deep-fascia STS prior to re-excision.