Unplanned excision of soft tissue sarcoma: the impact of the referring hospital.

Background: Unplanned excision of soft tissue sarcoma (STS) remains a common problem performed at various levels of hospitals, where clinical characteristics may differ. However, there is little literature describing the impact of the referring hospital on patient characteristics and/or outcome in unplanned excision of STS. This study examined the possible different patient characteristics and prognoses according to the level of referring hospitals where unplanned excision was performed.

Methods: Patients referred to our institute after unplanned excision of STS on their extremities were reviewed. Referring hospitals were categorized into two groups according to their referral grades; tertiary hospitals (general hospitals with tertiary [highest] referral grade, n = 42) and non-tertiary hospitals (others, n = 79).

Results: Patients referred from tertiary hospitals had significantly larger number of high-grade tumors (p = 0.019) but lower chance of finding a residual tumor at re-excision (p = 0.020) than non-tertiary hospitals. For oncological outcomes, referral from tertiary hospital was an independent factor for better local control (hazard ratio, 0.211; 95% confidence interval, 0.061-0.730). However, there was no difference in disease-specific death (p = 0.729) or metastasis (p = 0.978) between the two groups.

Conclusions: Despite having worse clinicopathologic characteristics, patients referred from tertiary hospitals had fewer local recurrences than patients from non-tertiary hospitals. The impact of the referring hospital on patient outcome and disease characteristics needs to be considered in unplanned excision of STS.