Long-term Oncologic Outcomes After Unplanned Soft Tissue Sarcoma Surgery: Implications for Surveillance Strategies

Area of Science:

• Oncology
• Surgical Pathology
• Cancer Research

Background:

• Unplanned excision of soft tissue sarcomas lacks proper preoperative planning, imaging, and histologic confirmation.
• While short-term risks are known, long-term outcomes of unplanned excisions remain understudied.

Purpose of the Study:

• To determine if unplanned excision is independently associated with worse overall survival, local recurrence-free survival, and metastatic disease-free survival compared to planned excision.
• To control for tumor grade, clinical stage, Charlson comorbidity index (CCI), and surgical margin status in the analysis.

Main Methods:

• Retrospective study of 396 patients (279 planned excision, 117 unplanned excision) with soft tissue sarcoma.
• Unplanned excision defined as resection without appropriate preoperative imaging or biopsy, or misinterpretation of findings.
• Kaplan-Meier analysis, log-rank testing, and multivariable Cox regression were used to compare survival outcomes at 5, 10, and 15 years.

Main Results:

• Overall survival was similar at 5 years but significantly lower after unplanned excision at 10 and 15 years.
• Metastatic disease-free survival was lower for unplanned excisions at all time points (5, 10, 15 years).
• Local recurrence-free survival was worse at 10 and 15 years for unplanned excisions. Multivariable analysis confirmed unplanned excision independently predicted worse overall and local recurrence-free survival.

Conclusions:

• Unplanned excision of soft tissue sarcoma is associated with worse long-term overall, local recurrence-free, and metastatic disease-free survival.
• The detrimental effects of unplanned excision become evident after 10 years, suggesting a need for extended oncologic surveillance.
• Further prospective studies are required to establish optimal surveillance strategies and the impact of early detection on outcomes.