Matthew T Houdek1, Mario Hevesi, Anthony M Griffin, Jay S Wunder, Peter C Ferguson. 1. From the University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada (Dr. Houdek, Mr. Griffin, Dr. Wunder, and Dr. Ferguson), and the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Houdek and Dr. Hevesi).
Abstract
BACKGROUND: Obesity is associated with wound complications after lower extremity surgery. Excision of soft-tissue sarcomas is urgent, and unlike the elective surgery, obesity cannot be modified preoperatively. The purpose of this study was to evaluate the effect of obesity on treatment outcome. METHODS: Six hundred fifty-three patients (343 men; mean age, 56 ± 18 years) with a lower extremity soft-tissue sarcoma were reviewed. The mean body mass index (BMI) was 27.1 ± 5.7 kg/m, with 189 obese patients (29%) having a BMI of ≥30 kg/m and 27 morbidly obese patients (4%) having a BMI of ≥40 kg/m. Complications and functional and oncologic outcomes were compared between groups. RESULTS: Two hundred eighty-five patients (40%) sustained a postoperative complication, most commonly a dehiscence (n = 175; 24%) and infection (n = 147; 21%). On multivariate analysis, morbid obesity was associated with wound complications (P = 0.002) and infection (P = 0.01). Morbid obesity was not associated with local tumor recurrence (P = 0.56). No difference was found in the mean Toronto Extremity Salvage Score (P = 0.11) or Musculoskeletal Tumor Society (P = 0.41) scores between the groups. DISCUSSION: Morbid obesity was associated with postoperative wound complications and infection. However, after surgery, obese patients can expect no difference in oncologic outcome, with an excellent functional result.
BACKGROUND:Obesity is associated with wound complications after lower extremity surgery. Excision of soft-tissue sarcomas is urgent, and unlike the elective surgery, obesity cannot be modified preoperatively. The purpose of this study was to evaluate the effect of obesity on treatment outcome. METHODS: Six hundred fifty-three patients (343 men; mean age, 56 ± 18 years) with a lower extremity soft-tissue sarcoma were reviewed. The mean body mass index (BMI) was 27.1 ± 5.7 kg/m, with 189 obesepatients (29%) having a BMI of ≥30 kg/m and 27 morbidly obesepatients (4%) having a BMI of ≥40 kg/m. Complications and functional and oncologic outcomes were compared between groups. RESULTS: Two hundred eighty-five patients (40%) sustained a postoperative complication, most commonly a dehiscence (n = 175; 24%) and infection (n = 147; 21%). On multivariate analysis, morbid obesity was associated with wound complications (P = 0.002) and infection (P = 0.01). Morbid obesity was not associated with local tumor recurrence (P = 0.56). No difference was found in the mean Toronto Extremity Salvage Score (P = 0.11) or Musculoskeletal Tumor Society (P = 0.41) scores between the groups. DISCUSSION: Morbid obesity was associated with postoperative wound complications and infection. However, after surgery, obesepatients can expect no difference in oncologic outcome, with an excellent functional result.
Authors: Adam Kline; Pramod Kamalapathy; Katharine Bruce; Kevin Raskin; Joseph Schwab; Santiago Lozano-Calderón Journal: Ann Surg Oncol Date: 2021-05-12 Impact factor: 5.344