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Annals of Surgical Oncology

, Volume 26, Issue 11, pp 3526–3534 | Cite as

Watch and Wait Approach for Re-excision After Unplanned Yet Macroscopically Complete Excision of Extremity and Superficial Truncal Soft Tissue Sarcoma is Safe and Does Not Affect Metastatic Risk or Amputation Rate

  • Gauthier DecanterEmail author
  • Eberhard Stoeckle
  • Charles Honore
  • Pierre Meeus
  • Jean Camille Mattei
  • Pascale Dubray-Longeras
  • Gwenael Ferron
  • Sébastien Carrere
  • Sylvain Causeret
  • Jean-Marc Guilloit
  • Magali Fau
  • Philippe Rosset
  • Jean-Christophe Machiavello
  • Jean Baptiste Delhorme
  • Nicolas Regenet
  • François Gouin
  • Jean-Yves Blay
  • Jean-Michel Coindre
  • Nicolas Penel
  • Sylvie Bonvalot
Sarcoma
  • 89 Downloads

Abstract

Background

The benefits of systematic re-excision (RE) after initial unplanned excision (UE) of soft tissue sarcoma (STS) are unknown.

Objective

The aim of this study was to evaluate the impact of delayed RE versus systematic RE after UE on overall survival (OS), metastatic relapse-free survival (MRFS), local relapse-free survival (LRFS), and rate of amputation.

Methods

Patients who underwent complete UE, without metastasis or residual disease, for primary extremity or superficial STS between 2007 and 2013 were analyzed. The amputation rate, LRFS, MRFS, and OS were assessed in cases of systematic RE in sarcoma referral centers (Group A), systematic RE outside of community centers (Group B), or without RE (Group C).

Results

Groups A, B, and C included 300 (48.2%), 71 (11.4%), and 251 (40.4%) patients, respectively. Median follow-up was 61 months and 5-year OS was 88.4%, 87.3%, and 88% in Groups A, B, and C, respectively (p = 0.22), while 5-year MFRS was 85.4%, 86.2%, and 84.9%, respectively (p = 0.938); RE (p = 0.55) did not influence MRFS. The 5-year LRFS was 83%, 73.5%, and 63.8% in Groups A, B and C, respectively (p = 0.00001). Of the 123 local recurrences observed, 0/28, 1/15, and 5/80 patients in Groups A, B, and C, respectively, required amputation (p = 0.41). Factors influencing LRFS were adjuvant radiotherapy [hazard ratio (HR) 0.21; p = 0.0001], initial R0 resection (HR 0.24, p = 0.0001), and Group A (HR 0.44; p = 0.01).

Conclusion

Systematic RE in sarcoma centers offers best local control but does not impact OS. Delayed RE at the time of local relapse, if any, could be an option.

Notes

Acknowledgment

The authors thank Loïc Lebellec, Francoise Ducimetiere, Antoine Giraud, and Séverine Marchant.

Disclosure

Gauthier Decanter, Eberhard Stoeckle, Charles Honore, Pierre Meeus, Jean Camille Mattei, Pascale Dubray-Longeras, Gwenael Ferron, Sébastien Carrere, Sylvain Causeret, Jean-Marc Guilloit, Magali Fau, Philippe Rosset, Jean-Christophe Machiavello, Jean Baptiste Delhorme, Nicolas Regenet, François Gouin, Jean-Yves Blay, Jean-Michel Coindre, Nicolas Penel, and Sylvie Bonvalot have no conflicts of interest to disclose.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Gauthier Decanter
    • 1
    • 2
    Email author
  • Eberhard Stoeckle
    • 3
  • Charles Honore
    • 4
  • Pierre Meeus
    • 5
  • Jean Camille Mattei
    • 6
  • Pascale Dubray-Longeras
    • 7
  • Gwenael Ferron
    • 8
  • Sébastien Carrere
    • 9
  • Sylvain Causeret
    • 10
  • Jean-Marc Guilloit
    • 11
  • Magali Fau
    • 12
  • Philippe Rosset
    • 13
  • Jean-Christophe Machiavello
    • 14
  • Jean Baptiste Delhorme
    • 15
  • Nicolas Regenet
    • 16
  • François Gouin
    • 17
  • Jean-Yves Blay
    • 18
  • Jean-Michel Coindre
    • 19
  • Nicolas Penel
    • 20
  • Sylvie Bonvalot
    • 21
  1. 1.Department of Medical OncologyOscar Lambret CenterLilleFrance
  2. 2.General Oncology DepartmentOscar Lambret Cancer CenterLilleFrance
  3. 3.Department of SurgeryBergonie InstituteBordeauxFrance
  4. 4.Department of Surgical OncologyGustave Roussy Cancer CampusVillejuifFrance
  5. 5.Department of Surgical OncologyCentre Léon BérardLyonFrance
  6. 6.Department of Orthopedic SurgeryHôpital NordMarseilleFrance
  7. 7.Department of Medical OncologyCentre Jean PerrinClermont-FerrandFrance
  8. 8.Department of Surgical OncologyInstitut Universitaire du Cancer de Toulouse – OncopoleToulouseFrance
  9. 9.Department of Surgical OncologyMontpellier Cancer CentreMontpellierFrance
  10. 10.Department of SurgeryCentre Georges François LeclercDijonFrance
  11. 11.Department of Medical OncologyRegional Cancer CentreCaenFrance
  12. 12.Department of Medical SurgeryCentre Alexis VautrinVandœuvre-lès-NancyFrance
  13. 13.Department of Orthopedic SurgeryUniversity Hospital of ToursToursFrance
  14. 14.Breast Cancer and Reconstructive Surgery UnitCentre Antoine LacassagneNiceFrance
  15. 15.Department of General and Digestive Surgery, Hautepierre HospitalStrasbourg University HospitalStrasbourgFrance
  16. 16.Department of Digestive SurgeryNantes HospitalNantesFrance
  17. 17.Department of Orthopedic SurgeryLeon Berard CenterLyonFrance
  18. 18.Department of Medical OncologyLeon Berard CenterLyonFrance
  19. 19.Department of PathologyBergonié Cancer InstituteBordeauxFrance
  20. 20.Medical Oncology DepartmentCentre Oscar Lambret and Lille University HospitalLilleFrance
  21. 21.Department of Medical Oncology and SurgeryGustave Roussy InstituteVillejuifFrance

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