© The Author (2008). Published by Oxford University Press. All rights reserved
Clinical Problems After Initial Unplanned Resection of Sarcoma
1 Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine
2 Department of Orthopedic Surgery, Yodogawa Christian Hospital
3 Department of Orthopedic Surgery, Osaka City General Hospital, Osaka, Japan
For reprints and all correspondence: Manabu Hoshi, Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi, Abeno-Ku, Osaka 545-8585, Japan. E-mail: hoshi{at}med.osaka-cu.ac.jp
Received April 17, 2008; accepted August 14, 2008
Objective: Unplanned resection of a sarcoma is often chosen in the early phase by general physicians without any imaging scrutiny. The present study aimed to highlight the clinical problems associated with unplanned resection of sarcomas.
Methods: Thirty-eight patients who underwent unplanned resection of a sarcoma and additional treatment were examined. The definite histological grading was high in 31 patients and low in 7 patients.
Results: The tumors were located in the depth of the subfascia in 13 patients. The maximal tumor sizes exceeded 5 cm in 16 patients. Preoperative MRI was only performed in six patients. The previous surgical margins were intralesional in 20 patients and marginal in 18 patients. Inappropriate transverse skin incisions were found in 21 patients. Extensive hematoma at the initial surgical site was seen in five patients. Thirty-three patients accepted additional wide resection due to the insufficient removal of malignancy. During an average follow-up of 42.7 months, seven patients died of lung and brain metastases.
Conclusions: On excision of any soft tissue tumor, surgeons should be aware of the potential risk for erroneous management of malignancy. If not, careless surgery may render the treatment protocol complicated and require excessive additional tissue resection with poor function and prognosis. Appropriate salvage treatment may have a significant role to play after unplanned resection of the sarcoma.
Key Words: surgery • sarcoma • unplanned resection