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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 2, 203-208.
doi: 10.1302/0301-620X.90B2.19760  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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The effect of an unplanned excision of a soft-tissue sarcoma on prognosis

C. R. Chandrasekar, MCh(Orth), FRCS(Orth), Orthopaedic Surgeon1; H. Wafa, MD, Senior Clinical Fellow1; R. J. Grimer, FRCS, Consultant Orthopaedic Surgeon1; S. R. Carter, FRCS, Consultant Orthopaedic Surgeon1; R. M. Tillman, FRCS(Orth), Consultant Orthopaedic Surgeon1; and A. Abudu, FRCS(Orth), Consultant Orthopaedic Surgeon1

1 The Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Birmingham B31 2AP, UK.

Correspondence should be sent to Mr R. J. Grimer; e-mail: rob.grimer{at}roh.nhs.uk

We investigated whether our policy of routine re-excision of the tumour bed after an unplanned excision of a soft-tissue sarcoma was justified.

Between April 1982 and December 2005, 2201 patients were referred to our hospital with the diagnosis of soft-tissue sarcoma, of whom 402 (18%) had undergone an unplanned excision elsewhere. A total of 363 (16.5%) were included in this study. Each patient was routinely restaged and the original histology was reviewed. Re-excision was undertaken in 316 (87%). We analysed the patient, tumour and treatment factors in relation to local control, metastasis and overall survival.

Residual tumour was found in 188 patients (59%). There was thus no residual disease in 128 patients of whom 10% (13) went on to develop a local recurrence. In 149 patients (47%), the re-excision specimen contained residual tumour, but it had been widely excised. Local recurrence occurred in 30 of these patients (20%). In 39 patients (12%), residual tumour was present in a marginal resection specimen. Of these, 46% (18) developed a local recurrence. A final positive margin in a high-grade tumour had a 60% risk of local recurrence even with post-operative radiotherapy.

Metastases developed in 24% (86). The overall survival was 77% at five years. Survival was related to the grade of the tumour and the finding of residual tumour at the time of re-excision.

We concluded that our policy of routine re-excision after unplanned excision of soft-tissue sarcoma was justified in view of the high risk of finding residual tumour.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General