Safe-margin surgery by plastic reconstruction in extremities or parietal trunk soft tissue sarcoma: A tertiary single centre experience
| Autor: | Benoit Boura, Dimitri Tzanis, Laurent Chiche, Lauren Darrigues, Benoit Couturaud, Jean Philippe Binder, Laura Samà, Julie Perlbarg-Samson, Toufik Bouhadiba, Nayla Nicolas, Sylvie Helfre, Sylvie Bonvalot, Damiano Gentile |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Soft Tissue Neoplasms Free Tissue Flaps medicine Humans Retrospective Studies business.industry Soft tissue sarcoma Soft tissue Margins of Excision Retrospective cohort study Extremities Sarcoma General Medicine Vascular surgery Plastic Surgery Procedures medicine.disease Surgery Oncoplastic Surgery Plastic surgery Oncology Amputation Neoplasm Recurrence Local business |
| Zdroj: | European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 48(3) |
| ISSN: | 1532-2157 |
| Popis: | Introduction Tertiary centers recruit a large proportion of locally advanced or recurrent soft tissue sarcomas (STSs) that may have been preoperatively irradiated. The objective of this study was to evaluate the results of oncoplastic surgery (OPS) for patients affected by extremities or parietal trunk STS. Materials and methods This retrospective study includes patients who underwent a flap reconstruction after sarcoma resection between January 2018 and December 2020 at Institut Curie. The primary endpoint was the evaluation of the impact of OPS on the quality of surgical margins. The secondary endpoint was to quantify the morbidity of OPS and identify predictive factors for wound complications. Results Of 211 patients, 89 (42.2%) had a flap reconstruction. Surgery was realized on an irradiated field in 56 (62.9%) patients. Without OPS, all patients were candidates either for amputation (n = 9,10.1%) due to vessels/nerve infiltration, or R1/R2 resection (n = 80,89.9%). Seventy-two (80.0%) pedicle flaps and 18 (20.0%) free flaps were used. No R2 resections were performed. R0 and R1 margins were achieved in 82 (92.1%) and 7 (7.9%), respectively. The median closest margin was 3 mm (IQR 1–6 mm). Among R1 patients, 5 had positive margins along a preserved critical structure, 2 patients had well-differentiated liposarcomas. The surgical morbidity rate was 33.3% (30/90 flaps). The reoperation rate was 15.7% (14/89 patients). Conclusions In a referral sarcoma center, the collaboration between the surgical oncologist and the plastic surgery team should be considered upfront in the surgical plan, allowing the most adequate wide oncological resection with acceptable postoperative morbidity. |
| Databáze: | OpenAIRE |
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