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Updated: Sep 19, 2026
A Mouse Model of Incompletely Resected Soft Tissue Sarcoma for Testing (Neo)adjuvant Therapies
Published on: July 28, 2020
A nationwide study on wound complications after pediatric extremity soft tissue sarcoma surgery
B Schuitema1, J H M Merks2, J H Coert3
1Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Plastic and Reconstructive Surgery University Medical Center Utrecht.
Background:
Surgical resection of extremity soft tissue sarcomas (eSTS) in children carries a risk of postoperative complications. However, their prevalence and risk factors remain poorly described, with evidence limited to small series. This study describes the prevalence and risk factors for postoperative complications following pediatric eSTS resection in a nationwide cohort.
Methods:
This retrospective nationwide cohort study, based on the Dutch Childhood Oncology Group (DCOG) registry, included all children (<18 years) who underwent eSTS resection between 2003 and 2025. The primary endpoint was surgery-related wound complications within 90 days after initial resection, classified according to the Clavien-Dindo system. The secondary endpoint was the use of reconstructive procedures for soft tissue coverage. Associations between clinical covariates and complications were analyzed.
Results:
Of 109 patients identified, 76 were eligible for analysis. Postoperative wound complications occurred in 14 patients (18%), including nine minor (12%) and five major (7%). Neoadjuvant chemotherapy was associated with an increased risk of postoperative wound complications (OR 4.27; 95% CI 1.16-15.71, p = 0.030), as was preoperative radiotherapy (OR 3.84; 95% CI 1.05-14.05, p = 0.043). The incidence of wound complications was stable across treatment eras. Although not statistically significant, lower extremity location showed higher odds of complications than the upper extremity (OR 3.96; 95% CI 0.81-19.30, p = 0.087). Reconstructive procedures for soft tissue coverage were performed in nine patients (12%).
Conclusion:
In this nationwide pediatric cohort, postoperative wound complications occurred in 18% of children undergoing eSTS resection and were associated with neoadjuvant chemotherapy and preoperative radiotherapy. Given the limited number of events, these associations should be interpreted with caution. This highlights the importance of multidisciplinary planning when neoadjuvant therapy and/or preoperative radiotherapy is combined with limb-sparing surgery. Reconstructive procedures for soft tissue coverage were infrequently used.
