Objective: To determine whether reresection affects survival in patients with inadequately resected, primary extremity soft tissue sarcoma. This study correlates reresection with local recurrence-free survival, metastasis-free survival, and disease-free survival.
Summary Background Data: Soft tissue sarcomas are rare neoplasms, with an incidence of approximately 6,000 per year in the United States. Because these tumors are rare and benign soft tissue tumors are common, many are initially thought to be benign and are excised without wide margins.
Methods: Patients who underwent treatment for primary tumors from July 1982 to June 1999 at a single institution were the subject of study. Two groups of patients were analyzed: those who underwent one definitive resection (one operation) and those whose tumors were previously resected and who were then referred for subsequent reresection (two operations). Patients were given adjuvant radiation or chemotherapy according to the standard of care.
Results: Of 1,092 patients with primary extremity soft tissue sarcoma underwent resection, 685 underwent definitive radical resection and 407 underwent reresection after undergoing excisional resection elsewhere. Median follow-up was 4.8 years. The 5-year disease-free survival rate of the definitive resection (one operation) group was 70%; that of the reresection (two operations) group was 88%. On multivariate analysis, reresection was adjusted and controlled for age, grade, depth, size, histology, and margins. Reresection remained a significant predictor of improved disease-free survival, even after these adjustments. To determine whether this difference was stage- or referral-biased, the patient population was divided by AJCC stage. In all stages there was a trend toward improved outcome; this was most marked for those with stage III disease (>5 cm, high-grade, and deep).
Conclusions: Patients with extremity soft tissue sarcoma who undergo reresection with two primary operations have an improved survival compared with those who undergo one operation. The most plausible explanation, referral and selection bias, is questionable given the significance of reresection as a variable after adjusting for stage and other risk factors. This suggests that where indicated and possible, reresection should be liberally applied in patients with primary extremity soft tissue sarcoma.
Soft tissue sarcomas are rare neoplasms, with an annual incidence of approximately 6,000 in the United States. 1 Because these tumors are rare and benign soft tissue tumors are common, many are initially thought to be benign and are excised without wide margins. After the diagnosis of sarcoma is made, these patients are usually referred to a specialist center. A reexcision is performed to obtain an adequate margin, and appropriate adjuvant multimodality therapy, where indicated, is administered. The rationale for reexcision is predicated on the principle that resection margin affects survival, although most of these studies have examined this for local recurrence. 1-4 In addition, severalstudies have documented patient benefit from the improved treatment of rare tumors at a specialist center, and this has been specifically addressed in soft tissue sarcoma. 2-4
We tested the hypothesis that reresection has an impact on survival. The aim of this study was to analyze survival outcome in a large, well-characterized cohort of prospectively followed-up patients with primary extremity soft tissue sarcoma who were initially treated at a cancer specialist center versus those who underwent initial resection elsewhere and were subsequently referred for reresection. In these patients, we analyzed the effect of reresection on local recurrence-free survival, metastasis-free survival, and disease-free survival.