Reexcision of soft tissue sarcoma: sufficient local control but increased rate of metastasis.

BACKGROUND: Assuming a benign tumor, soft tissue sarcomas are often treated by inadequate resection. The concept of reexcision in these patients is still under debate. Therefore, it was our goal to evaluate the results of this treatment with particular respect to residual tumor.
METHODS: During a 14-year period, a total of 143 patients were referred to Heinrich-Heine-University Düsseldorf and the University of Hamburg [corrected] after unplanned excision. Reexcision was performed in 139 patients. The assessed endpoints were local recurrence-free survival, distant metastasis-free survival, and tumor-related mortality. Univariate and multivariate analyses were performed using a log-rank test and Cox's proportional-hazard models.
RESULTS: Over a median observation period of 109 months, local recurrence appeared in 18 patients (12%) and distant metastasis in 46 patients (33%). Residual tumor was detected in 43 patients (31%) and was significantly associated with reduced relapse-free and overall survival. Local recurrence, however, was not affected.
CONCLUSIONS: Despite an incomplete initial resection, reexcision enables local control similar to that in patients without residual tumor. Still, these patients have a worse prognosis owing to an increased rate of distant metastasis; therefore, patients with soft tissue masses of unknown identity should be transferred to centers that specialize in treating sarcomas for adequate initial resection.