Primary excision compared with re-excision of extremity soft tissue sarcomas--is anything new?

Background: Soft tissue sarcomas (STS) are rare and are commonly excised outside of a sarcoma center without appropriate preoperative planning. Studies have shown varying results in survival and outcome when comparing patients undergoing re-excision to patients undergoing a single, planned excision.

Methods: This retrospective study evaluated 278 patients treated for STS of the extremities between January 2000 and July 2006. One hundred seventy-two patients had a primary excision while 106 patients had a sarcoma re-excised. Survival curves for disease-free survival, metastasis-free survival, and local recurrence-free survival were calculated using competing risk analysis for both groups.

Results: After adjusting for high-risk variables, our results indicate that re-excision is a proxy for smaller, low-grade tumors which tend to have a better survival profile. Death due to sarcoma and distant metastases were correlated with high-grade and large tumors. The presence of positive microscopic margins was the strongest predictor of local recurrence (P < 0.05).

Conclusions: There were no differences in death, metastases, or local recurrence between the two groups after adjusting for high-risk variables. Survival advantages previously reported with STS re-excision serve as proxy for tumors that have a better survival profile.