Outcomes of plastic surgical reconstruction in extremity and truncal soft tissue sarcoma: Results from the US Sarcoma Collaborative

• Published in: Journal of surgical oncology Vol. 127; no. 4; pp. 550 - 559
• Main Authors: Thalji, Sam Z., Ethun, Cecilia G., Tsai, Susan, Gamblin, T. Clark, Clarke, Callisia N., Bedi, Meena, King, David, LoGiudice, John, Poultsides, George, Grignol, Valerie P., Tseng, Jennifer, Votanopoulos, Konstantinos, Fields, Ryan C., Cardona, Kenneth, Mogal, Harveshp
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2023
• Subjects: Extremities - pathology; Extremities - surgery; extremity and truncal soft tissue sarcoma; Humans; multidisciplinary; Plastic Surgery Procedures; plastic surgical reconstruction; Postoperative Complications - epidemiology; Postoperative Complications - surgery; Radiation; Retrospective Studies; Sarcoma; Sarcoma - pathology; Soft Tissue Neoplasms - surgery; Torso - pathology; Torso - surgery; plastic surgical reconstruction; multidisciplinary; extremity and truncal soft tissue sarcoma
• ISSN: 0022-4790; 1096-9098; 1096-9098
• DOI: 10.1002/jso.27169

Background This study aimed to define how utilization of plastic surgical reconstruction (PSR) affects perioperative outcomes, locoregional recurrence‐free survival (LRRFS), and overall survival (OS) after radical resection of extremity and truncal soft tissue sarcoma (ETSTS). The secondary aim was to determine factors associated with PSR. Methods Patients who underwent resection of ETSTS between 2000 and 2016 were identified from a multi‐institutional database. PSR was defined as complex primary closure requiring a plastic surgeon, skin graft, or tissue‐flap reconstruction. Outcomes included PSR utilization, postoperative complications, LRRFS, and OS. Results Of 2750 distinct operations, 1060 (38.55%) involved PSR. Tissue‐flaps (854, 80.57%) were most commonly utilized. PSR was associated with a higher proportion of R0 resections (83.38% vs. 74.42%, p < 0.001). Tissue‐flap PSR was associated with local wound complications (odds ratio: 1.81, confidence interval: 1.21–2.72, p = 0.004). Neither PSR nor postoperative complications were independently associated with LRRFS or OS. High‐grade tumors (1.60, 1.13–2.26, p = 0.008) and neoadjuvant radiation (1.66, 1.20–2.30, p = 0.002) were associated with the need for PSR. Conclusion Patients with ETSTS undergoing resection with PSR experienced acceptable rates of complications and a higher rate of negative margins, which were associated with improved LRRFS and OS. High tumor grade and neoadjuvant radiation were associated with requirement of PSR.