Impact of unplanned excision on prognosis of patients with soft tissue sarcoma in adults: A comparative study at Regional Cancer Centre

Kapil Dev; Sandeep Nayak P; Arun Pandey; Shiva Kumar; Jaiprakash Gurawalia; Vishnu Kurpad

Volume : VI, Issue : III, March - 2017

Impact of unplanned excision on prognosis of patients with soft tissue sarcoma in adults: A comparative study at Regional Cancer Centre

Kapil Dev, Sandeep Nayak P, Arun Pandey, Shiva Kumar, Jaiprakash Gurawalia, Vishnu Kurpad

Abstract :

Introduction: Soft tissue sarcoma is a heterogeneous group of malignant mesenchymal tumours, and accounts for approximately 1% of all malignancies. The preoperative evaluation of the disease with specific radiological and histopathological examination has a pivotal role in the management. The unplanned excision of these tumours has a significant role in terms of oncological outcome in about 24% to 60% of all patients. Aim of this study was to compare the outcomes of planned excision, with those of re–excision after unplanned surgery in terms of local recurrence and distant metastasis. Material and methods: A retrospective analysis of the recorded data was done for patients, who presented with soft tissue sarcoma from 2005 to 2014 at our institute. All patients were classified in to two groups, �planned excision� and �re–excision after unplanned excision�. Patients with a median follow up of 25 months, with existing complete records were analysed. Results: After exclusion, a total of 320 patients were enrolled in our study. 253 patients underwent �planned excision� after an optimum pre–operative assessment, and 67 patients underwent �re–excision� for either residual or recurrent disease after a previous unplanned excision. The rate of local recurrence was higher in �re–excision� group, but statistically insignificant (17.9% vs 12.6%; p=0.1). Distant recurrences were more with �re–excision�, but statistically insignificant (7.5% vs 4.3%; p=0.2). Conclusion: Unplanned excision of STS has higher local recurrence and distant metastasis rates even after favourable baseline features. Soft tissue mass over any part of body of unknown identity should be appropriately imaged, biopsied and managed by the Oncologist at a specialized centre. Re–excision following unplanned excision has higher frequency of positive surgical margin leading to local recurrence as well as distant metastasis.