The Oncologic Impact of Postoperative Complications Following Resection of Truncal and Extremity Soft Tissue Sarcomas.

Autor: Broecker JS; Division of Surgical Oncology, Department of Surgery, Emory Winship Cancer Institute, Emory University, Atlanta, GA, USA., Ethun CG; Division of Surgical Oncology, Department of Surgery, Emory Winship Cancer Institute, Emory University, Atlanta, GA, USA., Monson DK; Department of Orthopedic Surgery, Emory University, Atlanta, GA, USA., Lopez-Aguiar AG; Division of Surgical Oncology, Department of Surgery, Emory Winship Cancer Institute, Emory University, Atlanta, GA, USA., Le N; Division of Surgical Oncology, Department of Surgery, Emory Winship Cancer Institute, Emory University, Atlanta, GA, USA., McInnis M; Division of Surgical Oncology, Department of Surgery, Emory Winship Cancer Institute, Emory University, Atlanta, GA, USA., Godette K; Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA., Reimer NB; Department of Orthopedic Surgery, Emory University, Atlanta, GA, USA., Oskouei SV; Department of Orthopedic Surgery, Emory University, Atlanta, GA, USA., Delman KA; Division of Surgical Oncology, Department of Surgery, Emory Winship Cancer Institute, Emory University, Atlanta, GA, USA., Staley CA; Division of Surgical Oncology, Department of Surgery, Emory Winship Cancer Institute, Emory University, Atlanta, GA, USA., Maithel SK; Division of Surgical Oncology, Department of Surgery, Emory Winship Cancer Institute, Emory University, Atlanta, GA, USA., Cardona K; Division of Surgical Oncology, Department of Surgery, Emory Winship Cancer Institute, Emory University, Atlanta, GA, USA. ken.cardona@emory.edu.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2017 Nov; Vol. 24 (12), pp. 3574-3586. Date of Electronic Publication: 2017 Sep 11.
DOI: 10.1245/s10434-017-6034-9
Abstrakt: Introduction: Postoperative complications (POCs) negatively impact oncologic outcomes in some malignancies; however, little is known regarding their effect in soft tissue sarcoma (STS). The aim of this study was to determine the impact of POCs on survival after resection of truncal and extremity STS.
Methods: All patients who underwent resection for a primary truncal or extremity STS at a single academic institution from 2000 to 2015 were included and analyzed. Primary outcome was disease-specific survival (DSS).
Results: Among 546 STS patients, POCs occurred in 159 (29%) patients; 57% were major and 55% were surgical site infections. Patients with POCs were older (61 vs. 53 years), had more comorbidities (50 vs. 38%), longer operative time (127 vs. 93 min), higher-grade tumors (93 vs. 86%), and were more likely to receive preoperative radiation (42 vs. 33%; all p < 0.05). There was no difference in receipt of postoperative therapy between the POCs and no POCs groups (19 vs. 18%, p = 0.74). Median follow-up for survivors was 37 months, and the 5-year DSS for the entire cohort was 78%. Compared with patients without POCs, patients with POCs had a worse DSS (68% vs. 81%, p = 0.001). Predictors for decreased DSS on univariate analysis included POCs (hazard ratio [HR] 2.12, 95% confidence interval [CI] 1.37-3.28, p = 0.001), advanced age, neurovascular/bone resection, positive margin, high grade, and preoperative and postoperative therapy (all p < 0.05). POCs (HR 1.76, 95% CI 1.08-2.87, p = 0.02) remained an independent predictor for reduced DSS on multivariate analysis, along with age (HR 1.02, p = 0.046) and tumor grade (HR 7.62, p = 0.046).
Conclusions: POCs following resection of truncal and extremity STS are associated with decreased DSS. Efforts to optimize modifiable risk factors and decrease the rate of POCs warrant further investigation.
Databáze: MEDLINE
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