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Abstract：
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.
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.
摘要：
背景：在软组织肉瘤中，计划外切除,或者所谓的呼号程序，确实经常发生，因此主要是由于良性病变的大量存在。再切除是否减少局部复发或改善总体生存率仍然是一个持续争论的话题。这项研究的主要目的是通过比较切除与拒绝手术的个体的再切除，分析四肢或躯干壁软组织肉瘤患者的预后。
方法：共纳入185例接受非计划切除的患者。这些患者被分为两组：A组（n=156）接受了再次切除，B组(n=29)采用保守治疗。根据临床情况，放疗或化疗要么在新辅助治疗或辅助治疗中进行.记录了残留肿瘤和转移性疾病的存在。临床结果,特别是局部复发(LR)，无局部复发生存率（LRFS）和总生存率（OS），用于评估。
结果：B组表现出明显更大的肿瘤（p<0.0001）和高于A组的平均年龄。在A组患者中，11例（5.9%）切除边缘（R1）受污染，在切除标本中观察到93例（59.6％）残留病（RD）。B组,10例患者单独接受辅助放疗，5只接受化疗，13例患者接受了由放疗和化疗组成的联合治疗.A组,8％（n=12）的患者在观察期间出现局部复发（LR）。相反，B组,这个数量是14%（n=4）（n.s.）。在A组的12名LR中，在残留病亚组中发现10例。两组之间的总生存率和无局部复发生存率没有显着差异。A组中共有15%(n=24)的患者发展为转移性疾病,而B组中10%(n=3)发生转移性疾病(n.s.)。
结论：非计划切除的STS再切除后，与未接受再切除术的患者相比,总生存期或LR无统计学显著差异.然而,在再次切除标本中残留疾病的患者亚组内，操作系统遭到破坏，LR率较高。特别是对于低度病变，采取更保守的方法似乎是合理的。
方法：共纳入185例接受非计划切除的患者。这些患者被分为两组：A组（n=156）接受了再次切除，B组(n=29)采用保守治疗。根据临床情况，放疗或化疗要么在新辅助治疗或辅助治疗中进行.记录了残留肿瘤和转移性疾病的存在。临床结果,特别是局部复发(LR)，无局部复发生存率（LRFS）和总生存率（OS），用于评估。
结果：B组表现出明显更大的肿瘤（p<0.0001）和高于A组的平均年龄。在A组患者中，11例（5.9%）切除边缘（R1）受污染，在切除标本中观察到93例（59.6％）残留病（RD）。B组,10例患者单独接受辅助放疗，5只接受化疗，13例患者接受了由放疗和化疗组成的联合治疗.A组,8％（n=12）的患者在观察期间出现局部复发（LR）。相反，B组,这个数量是14%（n=4）（n.s.）。在A组的12名LR中，在残留病亚组中发现10例。两组之间的总生存率和无局部复发生存率没有显着差异。A组中共有15%(n=24)的患者发展为转移性疾病,而B组中10%(n=3)发生转移性疾病(n.s.)。
结论：非计划切除的STS再切除后，与未接受再切除术的患者相比,总生存期或LR无统计学显著差异.然而,在再次切除标本中残留疾病的患者亚组内，操作系统遭到破坏，LR率较高。特别是对于低度病变，采取更保守的方法似乎是合理的。
