Soft tissue sarcoma of the hand: Is unplanned excision a problem?

Background: Soft tissue sarcoma (STS) of the hand are prone to unplanned excisions, altering oncologic outcomes. The aim of this study is to compare STS of the hand with initial treatment at an oncology center versus those initially treated at a non-oncology center. Additionally, we evaluated what factors were associated with oncologic outcomes.

Methods: We retrospectively identified patients with a STS of the hand using ICD-9 codes along with an institutional oncologic database. We included all adult patients with a non-metastatic STS of the hand (n = 64) with a median follow up of 4.0 years (IQR:1.7-10.0).

Results: Eight-three percent (n = 53) of tumors had an unplanned excision, of which one was treated at the oncology center. Patients treated primarily at an oncology center were older (57.6 vs. 43.6 years), had fewer operations and tended to have a larger tumors (median 4.7 cm vs. 3.0 cm) compared to those initially treated at a non-oncology center. The 5-year survival for patients treated at an oncology center was 60% compared to 89% in those initially treated at a non-oncology center. Worse disease-free survival was associated with positive final margins and subfascial tumors.

Conclusion: Tumors with primary treatment at an oncology center were larger and presented in older patients, having worse overall survival compared to those initially treated at a non-oncology center. Initial treatment at a non-oncology center did not influence the oncologic outcomes, but lead to more re-excisions and amputations. Final tumor margins and tumor depth determined oncologic outcomes.