Pre-operative evaluation prior to soft tissue sarcoma excision - Why can't we get it right?

Autor: Mesko NW; Cleveland Clinic Foundation, Department of Orthopaedic Surgery, 9500 Euclid Ave, Crile Building - A41, Cleveland, OH 44195, USA. Electronic address: meskon@ccf.org., Wilson RJ; Vanderbilt University Medical Center, Department of Orthopaedics and Rehabilitation, 1215 21st Ave S #4200, Nashville, TN 37232, USA. Electronic address: Robert.Wilson3@uphs.upenn.edu., Lawrenz JM; Cleveland Clinic Foundation, Department of Orthopaedic Surgery, 9500 Euclid Ave, Crile Building - A41, Cleveland, OH 44195, USA. Electronic address: lawrenj4@ccf.org., Mathieu JL; Vanderbilt University Medical Center, Department of Orthopaedics and Rehabilitation, 1215 21st Ave S #4200, Nashville, TN 37232, USA. Electronic address: jmathieu108@gmail.com., Ghiam MK; Vanderbilt University Medical Center, Department of Orthopaedics and Rehabilitation, 1215 21st Ave S #4200, Nashville, TN 37232, USA. Electronic address: mkghiam@gmail.com., Mathis SL; University of Alabama in Huntsville, Department of Kinesiology, 301 Sparkman Drive, Roberts Hall, Huntsville, AL 35899, USA. Electronic address: Shannon.Mathis@uah.edu., Halpern JL; Vanderbilt University Medical Center, Department of Orthopaedics and Rehabilitation, 1215 21st Ave S #4200, Nashville, TN 37232, USA. Electronic address: Jennifer.Halpern@vanderbilt.edu., Schwartz HS; Vanderbilt University Medical Center, Department of Orthopaedics and Rehabilitation, 1215 21st Ave S #4200, Nashville, TN 37232, USA. Electronic address: Herbert.S.Schwartz@vanderbilt.edu., Holt GE; Vanderbilt University Medical Center, Department of Orthopaedics and Rehabilitation, 1215 21st Ave S #4200, Nashville, TN 37232, USA. Electronic address: Ginger.E.Holt@vanderbilt.edu.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2018 Feb; Vol. 44 (2), pp. 243-250. Date of Electronic Publication: 2017 Nov 20.
DOI: 10.1016/j.ejso.2017.11.001
Abstrakt: Background: To define the association between an appropriate pre-operative workup (pre-operative advanced imaging studies, diagnostic biopsy) and incomplete soft tissue sarcoma (STS) excision.
Patients and Methods: This was a retrospective review of 397 consecutive patient records (2000-2008), looking at primary site advanced imaging (MRI or CT) and diagnostic biopsy procedures completed prior to the initial attempt at definitive surgical excision. Downstream effects of an inadequate pre-operative workup were also evaluated, including time to referral to a sarcoma multi-disciplinary care team and perceived alteration of surgical care in order to obtain a complete excision of the altered sarcoma bed.
Results: Thirty-eight percent (149/397) of soft tissue sarcomas identified underwent an incomplete excision prior to referral. A significant difference in the incidence of pre-operative primary site advanced imaging (91% vs. 42%, p < 0.001) and a pre-operative diagnostic biopsy (85% vs. 16%, p < 0.001) was found between the wide excision group and incomplete excision groups. Pre-operative biopsy (p < 0.001), tumor size >5 cm (p < 0.001), and a referral from an orthopaedic surgeon (p < 0.02) were all associated with reduced risk of incomplete excision in multivariate analysis. Seventy-four percent of patients in the incomplete excision group required an alteration in their definitive wide margin surgical resection, including rotational muscle flap coverage (37%), free flap coverage (11%), or amputation (11%).
Conclusion: A minority of patients referred following incomplete excision of a STS had undergone an appropriate pre-operative workup prior to referral, leading to increased long-term morbidity following definitive re-excision. Education efforts to heighten awareness of suspicious soft tissue lesions remain vital.
(Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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