Background: In soft tissue sarcomas, unplanned resections, or so-called Whoops procedures, do occur quite frequently, thus primarily owing to the abundant presence of benign lesions. Whether re-resection reduces local recurrence or improves overall survival remains a topic of ongoing debate. The principle objective of this study was to analyze the outcomes of patients with soft tissue sarcomas of the extremities or trunk wall after an incidental marginal resection by comparing re-resections to individuals who declined the procedure. Methods: A total of 185 patients who underwent unplanned resection were included. These patients were stratified into two groups: Group A (n = 156) underwent re-excision, while Group B (n = 29) was treated conservatively. Depending on the clinical scenario, radio- or chemotherapy was either administered in a neoadjuvant or an adjuvant setting. The presence of residual tumor and metastatic disease was documented. Clinical outcomes, specifically local recurrence (LR), local recurrence-free survival (LRFS) and overall survival (OS), were utilized for evaluation. Results: Group B exhibited significantly larger tumors (p< 0.0001) and a higher mean age than Group A. Among the patients in Group A, 11 (5.9%) had contaminated resection margins (R1), and residual disease (RD) was observed in 93 (59.6%) of the resected specimens. In group B, 10 patients received adjuvant radiotherapy alone, 5 received chemotherapy alone, and 13 underwent a combined approach consisting of both radio- and chemotherapy. In Group A, 8% (n = 12) of the patients developed local recurrence (LR) during the observation period. Conversely, in Group B, this amount was 14% (n = 4) (n.s.). Of the 12 LR in Group A, 10 were found in the subgroup with residual disease. Overall survival and local recurrence-free survival were not significantly different between the groups. A total of 15% (n = 24) of the patients in Group A developed metastatic disease, while 10% (n = 3) in Group B developed metastatic disease (n.s.). Conclusions: Following the reresection of unplanned resected STS, there was no statistically significant difference observed in overall survival or LR compared to patients who did not undergo re-resection. However, within the subgroup of patients with residual disease in the re-resected specimen, the OS was compromised, and the LR rate was higher. Particularly for low-grade lesions, adopting a more conservative approach seems to be justified.
背景：在软组织肉瘤中，非计划性切除（即所谓的"意外"手术）确实相当常见，这主要归因于良性病变的广泛存在。再次切除是否能降低局部复发率或提高总生存率，目前仍是一个持续争论的话题。本研究的主要目的是通过比较接受再次切除的患者与拒绝该手术的患者，分析四肢或躯干壁软组织肉瘤患者在意外边缘切除后的预后情况。方法：共纳入185例接受非计划性切除的患者。这些患者被分为两组：A组（n=156）接受了再次切除，而B组（n=29）接受了保守治疗。根据临床情况，在术前或术后进行了放疗或化疗。记录了残留肿瘤和转移性疾病的存在情况。采用临床结果，特别是局部复发（LR）、无局部复发生存期（LRFS）和总生存期（OS）进行评估。结果：B组的肿瘤体积显著大于A组（p<0.0001），平均年龄也更高。在A组患者中，11例（5.9%）存在切除边缘污染（R1），93例（59.6%）切除标本中观察到残留病灶（RD）。在B组中，10例患者仅接受辅助放疗，5例仅接受化疗，13例接受了放疗和化疗联合治疗。在观察期间，A组有8%（n=12）的患者出现局部复发（LR）。相反，在B组中，这一比例为14%（n=4）（无统计学意义）。在A组的12例局部复发中，10例出现在有残留病灶的亚组中。两组之间的总生存期和无局部复发生存期无显著差异。A组共有15%（n=24）的患者出现转移性疾病，而B组为10%（n=3）（无统计学意义）。结论：对于非计划性切除的软组织肉瘤进行再次切除后，与未接受再次切除的患者相比，总生存期或局部复发率均未观察到统计学上的显著差异。然而，在再次切除标本中存在残留病灶的患者亚组中，总生存期受到影响，局部复发率更高。特别是对于低级别病变，采取更保守的治疗方法似乎是合理的。
Unplanned Resections of Soft Tissue Sarcomas—Necessity of Re-Resection?
肿瘤(癌症)患者之家