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The Effect of Preoperative Radiotherapy and Reconstructive Surgery on Wound Complications after Resection of Extremity Soft-Tissue Sarcomas

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Abstract

Background

Major wound complications (MWCs) are frequent after preoperative radiotherapy (RT) for extremity soft-tissue sarcoma (STS). We examined the rate of MWCs at a single institution with readily available reconstructive surgery.

Methods

The medical records of consecutively treated extremity STS patients treated with preoperative external-beam RT and surgical resection from June 1996 through February 2003 were reviewed. Patients underwent RT (median 50 Gy), followed by resection 4–8 weeks later. Patients believed to be at higher risk for MWC underwent wound closure by the reconstructive surgery service (RSS). MWCs included secondary operation, invasive procedure, hospital readmission, or persistent deep packing or dressing changes.

Results

A total of 173 patients underwent preoperative RT. Median age was 54 years; 51% were female; 80% had lower extremity STS. Wound closure was performed by the primary surgeon in 91 cases (53%). The RSS performed wound closure in the remaining 82 patients (47%). One or more MWCs occurred in 55 patients (32%). Wound complications were more likely in patients with lower extremity (49/138, 36%) than upper extremity (6/35, 17%) STS (P = 0.03). Among patients with lower-risk wounds closed by the primary surgical team, 29 (32%) experienced MWC, whereas in the higher-risk patients closed by the RSS, MWC occurred in 26 (32%).

Conclusions

MWCs are frequent after preoperative RT and occur more commonly in patients with lower extremity tumors. The MWC rate observed in a single-institution setting was comparable to that observed in the preoperative therapy arm of a multicenter Canadian trial. Patients believed to be at higher risk for MWCs undergoing RSS closure have MWC rates comparable to those with lower-risk wounds closed by the primary team.

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Authors and Affiliations

  1. Sarcoma Center, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77230-1402, USA

    Jennifer F. Tseng MD, Matthew T. Ballo MD, Howard N. Langstein MD, Jeffrey D. Wayne MD, Janice N. Cormier MD, MPH, Kelly K. Hunt MD, Barry W. Feig MD, Alan W. Yasko MD, Valerae O. Lewis MD, Patrick P. Lin MD, Christopher P. Cannon MD, Gunar K. Zagars MD, Raphael E. Pollock MD, PhD & Peter W. T. Pisters MD

Authors
  1. Jennifer F. Tseng MD
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  2. Matthew T. Ballo MD
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  3. Howard N. Langstein MD
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  4. Jeffrey D. Wayne MD
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  5. Janice N. Cormier MD, MPH
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  6. Kelly K. Hunt MD
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  7. Barry W. Feig MD
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  8. Alan W. Yasko MD
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  9. Valerae O. Lewis MD
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  10. Patrick P. Lin MD
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  11. Christopher P. Cannon MD
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  12. Gunar K. Zagars MD
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  13. Raphael E. Pollock MD, PhD
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  14. Peter W. T. Pisters MD
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Corresponding author

Correspondence to Peter W. T. Pisters MD.

Additional information

Presented in part at the annual meeting of the Society of Surgical Oncology, March 3-5, 2005, Atlanta, GA.

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Tseng, J.F., Ballo, M.T., Langstein, H.N. et al. The Effect of Preoperative Radiotherapy and Reconstructive Surgery on Wound Complications after Resection of Extremity Soft-Tissue Sarcomas. Ann Surg Oncol 13, 1209–1215 (2006). https://doi.org/10.1245/s10434-006-9028-6

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  • DOI: https://doi.org/10.1245/s10434-006-9028-6

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