Preoperative Radiotherapy and Wide Resection for Soft Tissue Sarcomas: Achieving a Low Rate of Major Wound Complications with the Use of Flaps. Results of a Single Surgical Team

Overview

Journal Front Surg

Specialty General Surgery

Date 2018 Feb 7

PMID 29404337

Citations 1

Authors

Lester Wai Mon Chan

Jungo Imanishi

Damien Glen Grinsell

Peter Choong

Affiliations

Soon will be listed here.

Abstract

Background: Surgery in combination with radiotherapy (RT) has become the standard of care for most soft tissue sarcomas. The choice between pre- and postoperative RT is controversial. Preoperative RT is associated with a 32-35% rate of major wound complications (MWC) and 16-25% rate of reoperation. The role of vascularized soft tissue "flaps" in reducing complications is unclear. We report the outcomes of patients treated with preoperative RT, resection, and flap reconstruction.

Patients And Methods: 122 treatment episodes involving 117 patients were retrospectively reviewed. All patients were treated with 50.4 Gy of external beam radiation. Surgery was performed at 4-8 weeks after completion of RT by the same combination of orthopedic oncology and plastic reconstructive surgeon. Defects were reconstructed with 64 free and 59 pedicled/local flaps.

Results: 30 (25%) patients experienced a MWC and 17 (14%) required further surgery. 20% of complications were exclusively related to the donor site. There was complete or partial loss of three flaps. There was no difference in the rate of MWC or reoperation for complications with respect to age, sex, tumor site, previous unplanned excision, tumor grade, depth, and type of flap. Tumor size ≥8 cm was associated with a higher rate of reoperation (11/44 vs 6/78; = 0.008) but the rate of MWC was not significant (16/44 vs 14/78; = 0.066).

Conclusion: The use of soft tissue flaps is associated with a low rate of MWC and reoperation. Our results suggest that a high rate of flap usage may be required to observe a reduction in complication rates.

Citing Articles

Pedicled Functional Latissimus Flaps for Reconstruction of the Upper Extremity following Resection of Soft-Tissue Sarcomas.

Arguello A, Sullivan M, Mills G, Moran S, Houdek M Curr Oncol. 2023; 30(3):3138-3148.

PMID: 36975450 PMC: 10047364. DOI: 10.3390/curroncol30030237.

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