M. H. Nguyen1, J. Carr2, L. A. Damitz1, H. J. Kim2, C. Hultman1 1University Of North Carolina At Chapel Hill,Plastic Surgery Deparment,Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill,Department Of Surgical Oncology,Chapel Hill, NC, USA
Introduction: Neoadjuvant radiotherapy prior to surgical resection improves survival in patients with high-grade sarcomas, but less is known about the impact of tumor location, tumor type, and method of reconstruction on outcomes such as morbidity, recurrence, and mortality.
Methods: We performed a retrospective cohort analysis of all patients from our institutional sarcoma registry who underwent neoadjuvant radiotherapy, prior to surgical resection, from 1998-2015 (n=136). Both Surgical Oncology and Plastic Surgery were involved in pre-operative planning for wound closure. Patients were separated into type of reconstruction (flap vs complex repair) and location of tumor (extremity vs torso). Outcome measures were complications, length of stay, recurrence, and survival. Groups were compared by t-test and chi-square analysis, with significance assigned to p values <0.05.
Results: When compared to complex closure, the use of myocutaneous or fasciocutaneous flaps did not appear to confer any benefit, in terms of overall or wound complication rates, infection rates, recurrence, or survival (NS). Regarding location, tumors of the extremities, compared to torso, were associated with improved outcomes, in term of length of stay (3.8 vs 9.5 days, p<0.001), local recurrence (23.8% vs. 41.1%, p< 0.05) and disease-free survival (65% vs. 44.6%, p<0.05). The majority of soft tissue sarcomas in the extremities was liposarcoma (28.75%), while leiomyosarcoma was the most common tumor in the torso (40.35%). 80.3% of the non-extremity tumors were retroperitoneal, 36% of which had positive margins.
Conclusion: In this cohort of patients who had neoadjuvant radiotherapy, prior to sarcoma resection, extremity tumors were associated with better prognosis, in term of decreased length of stay, postoperative morbidity, recurrence, and improved disease-free survival, compared to tumors of the torso. Liposarcoma was more common in extremity, while leimoyosarcoma was more common in the torso. Interestingly, complex closure of the defects, despite neoadjuvant radiotherapy, achieved similar results as flap reconstruction, indicating that patients can be preoperatively sorted into the most appropriate reconstructive option. Complex repair should be considered, as a collaborative effort between Surgical Oncology and Plastic Surgery, in carefully selected patients, to avoid donor site morbidity and achieve equivalent outcomes.