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Planned and Unplanned Sarcoma Resections: Comparative Analysis of Local Recurrence, Metastasis, and Mortality

Affiliations
  • 1Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
  • 2Sarkomzentrum, Kliink für Orthopädie und Unfallchirurgie, LUKS University Hospital, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.
  • 3Medical Faculty, University of Zurich, 8032 Zurich, Switzerland.
  • 4Sarkomzentrum KSW, Klinik für Orthopädie und Traumatologie, Kantonsspital Winterthur, 8400 Winterthur, Switzerland.

Published on:

October 16, 2024

Abstract

BACKGROUND

Sarcomas, a diverse group of malignant tumors arising from mesenchymal tissues, pose significant diagnostic and therapeutic challenges. This study compares the outcomes of planned resections (PEs) and unplanned resections (UEs) to inform better clinical practices.

METHODS

Data were analyzed from the Swiss Sarcoma Network (SSN), including patients with soft tissue and bone sarcomas treated at two major hospitals. This study utilized logistic regression and Cox regression models to examine the odds of UEs and their impact on local recurrence-free survival.

RESULTS

Among 429 patients registered by SSN members, 323 (75%) underwent PEs and 106 (25%) experienced UEs. PEs were associated with significantly larger tumors (94 mm vs. 47 mm, < 0.001) and higher-grade tumors (Grade 3: 50.5% vs. 37.4%, = 0.03). Despite achieving superior resection margins (R0: 78.8% vs. 12.6%, < 0.001), PEs showed higher metastasis rates at follow-up (31.0% vs. 10.4%, < 0.001) and greater cancer-specific mortality (16.7% vs. 6.6%, = 0.01). UEs, while linked to higher local recurrence, did not significantly affect metastasis-free survival (MFS) or overall survival (OS).

CONCLUSIONS

PEs achieve superior immediate surgical outcomes but are linked to higher metastasis and cancer-specific mortality due to the advanced stage of tumors. UEs, while associated with higher local recurrence rates, do not significantly impact MFS or OS. Early detection, comprehensive diagnostics, and timely referrals to specialized sarcoma hubs are essential to avoid UEs and reduce metastatic risk. Future research should focus on developing diagnostic tools using individual tumor and patient characteristics to improve sarcoma management.

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