Evaluation of Surgical Resection and Reconstruction Outcomes in Patients with Various Histological Subtypes of Soft Tissue Sarcomas: A Prospective Cohort Analysis

Surgical Outcomes in Soft Tissue Sarcoma

Authors

  • Samia Fatima Postgraduate Medical Institute, Ameer-ud-Din Medical College, Lahore General Hospital, Lahore, Pakistan
  • Roomana Akhlaque Postgraduate Medical Institute, Ameer-ud-Din Medical College, Lahore General Hospital, Lahore, Pakistan
  • Muhammad Nasrullah Jinnah Burn and Reconstructive Surgery Centre, Allama Iqbal Medical College, Lahore, Pakistan
  • Muhammad Amin Postgraduate Medical Institute, Ameer-ud-Din Medical College, Lahore General Hospital, Lahore, Pakistan
  • Sana Imdad Postgraduate Medical Institute, Ameer-ud-Din Medical College, Lahore General Hospital, Lahore, Pakistan
  • Muhammad Imran Government Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i06.1689

Keywords:

Soft Tissue Sarcomas, Histological Subtypes, Surgical Resection

Abstract

Soft-tissue sarcomas (STS) are rare, especially as histological subtypes (more than 50). Despite being more prevalent in youngsters, their prevalence rises with age. Objective: To analyze the outcomes of surgical resection and subsequent reconstruction in patients with different histological subtypes of soft tissue sarcomas, focusing on the complications, recurrence rates, and overall survival. Methods: A prospective cohort study was conducted and data were collected from 14 patients treated between 2018 to 2022 at the Department of Plastic and Reconstructive Surgery, General Hospital, Lahore. The data included a detailed analysis of patient demographics, histological subtypes, surgical techniques, and postoperative outcomes, including complications, recurrence rates, and overall survival. Results: Soft tissue sarcoma was identified in 2 scalps, 2 arms, 3 forearms, 2 abdominal walls, 3 lower limbs, 1 nape of the neck, and 1 lumbar area. Two patients received neoadjuvant radiation and one chemotherapy. The tumors were 5–17.5 cm wide. Pleomorphic sarcoma was the most prevalent STS subtype, followed by liposarcoma and leiomyosarcoma in histology. This six-patient technique employed Latissimus dorsi, radial forearms, musculocutaneous gastrocnemius, free anterior lateral thigh (ALT) muscles, and year-end median. Complications occurred in 3 out of 14 patients who received flap reconstruction (complete flap failure in one patient, seroma in one patient, infection in one patient). The recurrence rate was 4 (28.6%) and survival rate was 13 (92.9%). Conclusions: This study concluded that R0 resection followed by immediate soft tissue reconstruction has helped in the management of such complex cases in terms of less complications and recurrence rate.

References

Gómez J and Tsagozis P. Multidisciplinary treatment of soft tissue sarcomas: an update. World Journal of Clinical Oncology. 2020 Apr; 11(4): 180-189. doi: 10.5306/wjco.v11.i4.180. DOI: https://doi.org/10.5306/wjco.v11.i4.180

Kjäldman M, Repo JP, Sampo M, Barner-Rasmussen I, Blomqvist C, Kask G et al. Functional assessment after treatment of upper extremity soft tissue sarcomas using structured outcome measures: A systematic review. Value in Health. 2017 Oct; 20(9): A764. doi: 10.1016/j.jval.2017.08.2171. DOI: https://doi.org/10.1016/j.jval.2017.08.2171

Stiles ZE, Lohman RF, Mann GN. Plastic surgery reconstruction of sarcoma resection defects: Form and function. Surgical Clinics. 2022 Aug; 102(4): 583-99. doi: 10.1016/j.suc.2022.04.008. DOI: https://doi.org/10.1016/j.suc.2022.04.008

Callegaro D, Miceli R, Mariani L, Raut CP, Gronchi A. Soft tissue sarcoma nomograms and their incorporation into practice. Cancer. 2017 Aug; 123(15): 2802-20. doi: 10.1002/cncr.30721. DOI: https://doi.org/10.1002/cncr.30721

Awad N, Lackman R, McMackin K, Kim TW, Lombardi J, Caputo F. Multidisciplinary approach to treatment of soft tissue sarcomas requiring complex oncologic resections. Annals of Vascular Surgery. 2018 Nov; 53: 212-6. doi: 10.1016/j.avsg.2018.04.035 DOI: https://doi.org/10.1016/j.avsg.2018.04.035

Angelini A, Tiengo C, Sonda R, Berizzi A, Bassetto F, Ruggieri P. One-stage soft tissue reconstruction following sarcoma excision: a personalized multidisciplinary approach called “orthoplasty”. Journal of Personalized Medicine. 2020 Dec; 10(4): 278. doi: 10.3390/jpm10040278. DOI: https://doi.org/10.3390/jpm10040278

De Matos CMM, de Araújo Filho IT, Fernandes MV, Macedo Barbosa DJ, André AT, Antoniou G. Soft Tissue Sarcomas. In: De Mello RA, Mountzios G, Tavares ÁA., editors. International Manual of Oncology Practice. Cham: Springer International Publishing, 2019: 775-99. 10.1007/978-3-030-16245-0_35. DOI: https://doi.org/10.1007/978-3-030-16245-0_35

Llovet JM, Pinyol R, Yarchoan M, Singal AG, Marron TU, Schwartz M et al. Adjuvant and neoadjuvant immunotherapies in hepatocellular carcinoma. Nature Reviews Clinical Oncology. 2024 Apr; 21(4): 294-311. doi: 10.1038/s41571-024-00868-0. DOI: https://doi.org/10.1038/s41571-024-00868-0

Crombé A, Marcellin PJ, Buy X, Stoeckle E, Brouste V, Italiano A et al. Soft-tissue sarcomas: assessment of MRI features correlating with histologic grade and patient outcome. Radiology. 2019 Jun; 291(3): 710-21. doi: 10.1148/radiol.2019181659. DOI: https://doi.org/10.1148/radiol.2019181659

Birgin E, Yang C, Hetjens S, Reissfelder C, Hohenberger P, Rahbari NN. Core needle biopsy versus incisional biopsy for differentiation of soft‐tissue sarcomas: a systematic review and meta‐analysis. Cancer. 2020 May; 126(9): 1917-28. doi: 10.1002/cncr.32735. DOI: https://doi.org/10.1002/cncr.32735

Osterloh J, Ludolph I, Grützmann R, Meyer A, Lang W, Horch RE et al. Interdisciplinary Surgical Therapy of Extremity Soft-Tissue Sarcomas: A Personalized Resection and Reconstruction Algorithm. Journal of Personalized Medicine. 2023 Jan; 13(2): 262. doi: 10.3390/jpm13020262. DOI: https://doi.org/10.3390/jpm13020262

Martin-Broto J, Hindi N, Grignani G, Martinez-Trufero J, Redondo A, Valverde C et al. Nivolumab and sunitinib combination in advanced soft tissue sarcomas: a multicenter, single-arm, phase Ib/II trial. Journal for Immunotherapy of Cancer. 2020 May; 8(2): e001561. doi: 10.1136/jitc-2020-001561. DOI: https://doi.org/10.1136/jitc-2020-001561

Wilky BA, Trucco MM, Subhawong TK, Florou V, Park W, Kwon D et al. Axitinib plus pembrolizumab in patients with advanced sarcomas including alveolar soft-part sarcoma: a single-centre, single-arm, phase 2 trial. The Lancet Oncology. 2019 Jun; 20(6): 837-48. doi: 10.1016/S1470-2045(19)30153-6. DOI: https://doi.org/10.1016/S1470-2045(19)30153-6

Toulmonde M, Pulido M, Ray-Coquard I, André T, Isambert N, Chevreau C et al. Pazopanib or methotrexate–vinblastine combination chemotherapy in adult patients with progressive desmoid tumours (DESMOPAZ): a non-comparative, randomised, open-label, multicentre, phase 2 study. The Lancet Oncology. 2019 Sep; 20(9): 1263-72. doi: 10.1016/S1470-2045(19)30276-1. DOI: https://doi.org/10.1016/S1470-2045(19)30276-1

Rothermundt C, Andreou D, Blay JY, Brodowicz T, Desar IM, Dileo P et al. Controversies in the management of patients with soft tissue sarcoma: Recommendations of the Conference on State of Science in Sarcoma 2022. European Journal of Cancer. 2023 Feb; 180: 158-79. doi: 10.1016/j.ejca.2022.11.008. DOI: https://doi.org/10.1016/j.ejca.2022.11.008

Palmerini E and Staals EL. Treatment updates on tenosynovial giant cell tumor. Current Opinion in Oncology. 2022 Jul; 34(4): 322-7. doi: 10.1016/j.ejca.2022.11.008. DOI: https://doi.org/10.1097/CCO.0000000000000853

Tsuchihashi K, Kusaba H, Yoshihiro T, Fujiwara T, Setsu N, Endo M et al. Eribulin as a first-line treatment for soft tissue sarcoma patients with contraindications for doxorubicin. Scientific reports. 2020 Dec; 10(1): 20896. doi: 10.1097/CCO.0000000000000853. DOI: https://doi.org/10.1038/s41598-020-77898-y

Tirotta F, Sayyed R, Jones RL, Hayes AJ. Risk factors for the development of local recurrence in extremity soft-tissue sarcoma. Expert Review of Anticancer Therapy. 2022 Jan; 22(1): 83-95. doi: 10.1080/14737140.2022.2011723. DOI: https://doi.org/10.1080/14737140.2022.2011723

Kannan S, Chong HH, Chew B, Ferguson JD, Galloway E, McCulloch T et al. Leiomyosarcoma in the extremities and trunk wall: systematic review and meta-analysis of the oncological outcomes. World Journal of Surgical Oncology. 2022 Apr; 20(1): 124. doi: 10.1186/s12957-022-02584-4. DOI: https://doi.org/10.1186/s12957-022-02584-4

Gounder M, Ratan R, Alcindor T, Schöffski P, Van Der Graaf WT, Wilky BA et al. Nirogacestat, a γ-secretase inhibitor for desmoid tumors. New England Journal of Medicine. 2023 Mar; 388(10): 898-912. doi: 10.1056/NEJMoa2210140. DOI: https://doi.org/10.1056/NEJMoa2210140

Sivarajah G, Snow H, Wilkinson MJ, Strauss DC, Smith MJ, Hayes AJ. Low local recurrence rates following marginal surgical resection of non-coelomic Atypical Lipomatous Tumours/Well-differentiated Liposarcomas. European Journal of Surgical Oncology. 2024 Jan; 50(1): 107301. doi: 10.1016/j.ejso.2023.107301. DOI: https://doi.org/10.1016/j.ejso.2023.107301

Götzl R, Sterzinger S, Arkudas A, Boos AM, Semrau S, Vassos N et al. The role of plastic reconstructive surgery in surgical therapy of soft tissue sarcomas. Cancers. 2020 Nov; 12(12): 3534. doi: 10.3390/cancers12123534. DOI: https://doi.org/10.3390/cancers12123534

Bedi M, King DM, DeVries J, Hackbarth DA, Neilson JC. Does vacuum-assisted closure reduce the risk of wound complications in patients with lower extremity sarcomas treated with preoperative radiation?. Clinical Orthopaedics and Related Research®. 2019 Apr; 477(4): 768-74. doi: 10.1097/CORR.0000000000000371. DOI: https://doi.org/10.1097/CORR.0000000000000371

Frank K, Ströbel A, Ludolph I, Hauck T, May MS, Beier JP et al. Improving the safety of DIEP flap transplantation: detailed perforator anatomy study using preoperative CTA. Journal of Personalized Medicine. 2022 Apr; 12(5): 701. doi: 10.3390/jpm12050701. DOI: https://doi.org/10.3390/jpm12050701

Geierlehner A, Horch RE, Ludolph I, Arkudas A. Intraoperative blood flow analysis of DIEP vs. ms-TRAM flap breast reconstruction combining transit-time flowmetry and microvascular indocyanine green angiography. Journal of Personalized Medicine. 2022 Mar; 12(3): 482. doi: 10.3390/jpm12030482. DOI: https://doi.org/10.3390/jpm12030482

Krauss S, Goertz O, Pakosch-Nowak D, Daigeler A, Harati K, Lehnhardt M et al. Microvascular tissue transfer after the resection of soft tissue sarcomas. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2021 May; 74(5): 995-1003. doi: 10.1016/j.bjps.2020.11.013. DOI: https://doi.org/10.1016/j.bjps.2020.11.013

Bigdeli AK, Didzun O, Thomas B, Harhaus L, Gazyakan E, Horch RE et al. Combined versus Single Perforator Propeller Flaps for Reconstruction of Large Soft Tissue Defects: A Retrospective Clinical Study. Journal of Personalized Medicine. 2022 Jan; 12(1): 41. doi: 10.3390/jpm12010041. DOI: https://doi.org/10.3390/jpm12010041

Ørholt M, Abebe K, Rasmussen LE, Aaberg FL, Lindskov LJ, Schmidt G et al. Atypical fibroxanthoma and pleomorphic dermal sarcoma: Local recurrence and metastasis in a nationwide population-based cohort of 1118 patients. Journal of the American Academy of Dermatology. 2023 Dec; 89(6): 1177-84. doi: 10.1016/j.jaad.2023.08.050. DOI: https://doi.org/10.1016/j.jaad.2023.08.050

Müller-Seubert W, Scheibl K, Bührer G, Möbius C, Ludolph I, Horch RE et al. Less is more–retrospective comparison of shoulder strength and range of motion between conventional and muscle-sparing harvesting technique of a latissimus dorsi flap. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2021 Oct; 74(10): 2527-36. doi: 10.1016/j.bjps.2021.02.007. DOI: https://doi.org/10.1016/j.bjps.2021.02.007

Downloads

Published

2024-06-30
CITATION
DOI: 10.54393/pjhs.v5i06.1689
Published: 2024-06-30

How to Cite

Fatima, S., Akhlaque, R., Nasrullah, M., Amin, M., Imdad, S., & Imran, M. (2024). Evaluation of Surgical Resection and Reconstruction Outcomes in Patients with Various Histological Subtypes of Soft Tissue Sarcomas: A Prospective Cohort Analysis: Surgical Outcomes in Soft Tissue Sarcoma. Pakistan Journal of Health Sciences, 5(06), 199–205. https://doi.org/10.54393/pjhs.v5i06.1689

Issue

Section

Original Article

Plaudit

Most read articles by the same author(s)