Jelena Slump1, Stefan O P Hofer2, Peter C Ferguson3, Jay S Wunder3, Anthony M Griffin3, Harald J Hoekstra4, Esther Bastiaannet5, Anne C O'Neill6. 1. Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada; Department of Surgical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands. 2. Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada. 3. University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada. 4. Department of Surgical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands. 5. Department of Surgical Oncology, Leiden University Medical Centre, Leiden, The Netherlands. 6. Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada. Electronic address: anne.oneill@uoftplasticsurgery.ca.
Abstract
BACKGROUND: Flap reconstruction plays an essential role in the surgical management of extremity soft tissue sarcoma (ESTS) for many patients. But flaps increase the duration and complexity of the surgery and their contribution to overall morbidity is unclear. This study directly compares the complication rates in patients with ESTS undergoing either flap reconstruction or primary wound closure and explores contributing factors. METHODS: Eight hundred and ninety-seven patients who underwent ESTS resection followed by primary closure (631) or flap reconstruction (266) were included in this study. Data on patient, tumour and treatment variables and post-operative medical and surgical complications were collected. Univariate and multivariate regression analyses were performed to identify independent predictors of complications. RESULTS: Post-operative complications occurred in 33% of patients. Flap patients were significantly older, had more advanced disease and were more likely to require neoadjuvant chemo- and radiotherapy. There was no significant difference in complication rates following flap reconstruction compared to primary closure on multivariate analysis (38 vs 30.9% OR 1.12, CI 0.77-1.64, p = 0.53). Pre-operative radiation and distal lower extremity tumour location were significant risk factors in patients who underwent primary wound closure but not in those who had flap reconstruction. Patients with comorbidities, increased BMI and systemic disease were at increased risk of complications following flap reconstruction. CONCLUSIONS: Flap reconstruction is not associated with increased post-operative complications following ESTS resection. Flaps may mitigate the effects of some risk factors in selected patients.
BACKGROUND: Flap reconstruction plays an essential role in the surgical management of extremity soft tissue sarcoma (ESTS) for many patients. But flaps increase the duration and complexity of the surgery and their contribution to overall morbidity is unclear. This study directly compares the complication rates in patients with ESTS undergoing either flap reconstruction or primary wound closure and explores contributing factors. METHODS: Eight hundred and ninety-seven patients who underwent ESTS resection followed by primary closure (631) or flap reconstruction (266) were included in this study. Data on patient, tumour and treatment variables and post-operative medical and surgical complications were collected. Univariate and multivariate regression analyses were performed to identify independent predictors of complications. RESULTS: Post-operative complications occurred in 33% of patients. Flap patients were significantly older, had more advanced disease and were more likely to require neoadjuvant chemo- and radiotherapy. There was no significant difference in complication rates following flap reconstruction compared to primary closure on multivariate analysis (38 vs 30.9% OR 1.12, CI 0.77-1.64, p = 0.53). Pre-operative radiation and distal lower extremity tumour location were significant risk factors in patients who underwent primary wound closure but not in those who had flap reconstruction. Patients with comorbidities, increased BMI and systemic disease were at increased risk of complications following flap reconstruction. CONCLUSIONS: Flap reconstruction is not associated with increased post-operative complications following ESTS resection. Flaps may mitigate the effects of some risk factors in selected patients.
Authors: Rebekka Götzl; Sebastian Sterzinger; Andreas Arkudas; Anja M Boos; Sabine Semrau; Nikolaos Vassos; Robert Grützmann; Abbas Agaimy; Werner Hohenberger; Raymund E Horch; Justus P Beier Journal: Cancers (Basel) Date: 2020-11-26 Impact factor: 6.639
Authors: Benjamin Thomas; Amir K Bigdeli; Steffen Nolte; Emre Gazyakan; Leila Harhaus; Oliver Bischel; Burkhard Lehner; Gerlinde Egerer; Gunhild Mechtersheimer; Peter Hohenberger; Raymund E Horch; Dimosthenis Andreou; Jochen Schmitt; Markus K Schuler; Martin Eichler; Ulrich Kneser Journal: Cancers (Basel) Date: 2022-09-02 Impact factor: 6.575