The effect of preoperative radiotherapy and reconstructive surgery on wound complications after resection of extremity soft-tissue sarcomas

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

Research output: Contribution to journalArticle

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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. Published by Springer Science+Business Media, Inc.

Original languageEnglish (US)
Pages (from-to)1209-1215
Number of pages7
JournalAnnals of Surgical Oncology
Volume13
Issue number9
DOIs
StatePublished - Sep 1 2006
Externally publishedYes

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Reconstructive Surgical Procedures
Sarcoma
Radiotherapy
Extremities
Wounds and Injuries
Lower Extremity

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

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The effect of preoperative radiotherapy and reconstructive surgery on wound complications after resection of extremity soft-tissue sarcomas. / Tseng, Jennifer F.; Ballo, Matthew; Langstein, Howard N.; Wayne, Jeffrey D.; Cormier, Janice N.; Hunt, Kelly K.; Feig, Barry W.; Yasko, Alan W.; Lewis, Valerae O.; Lin, Patrick P.; Cannon, Christopher P.; Zagars, Gunar K.; Pollock, Raphael E.; Pisters, Peter W.T.

In: Annals of Surgical Oncology, Vol. 13, No. 9, 01.09.2006, p. 1209-1215.

Research output: Contribution to journalArticle

Tseng, JF, Ballo, M, Langstein, HN, Wayne, JD, Cormier, JN, Hunt, KK, Feig, BW, Yasko, AW, Lewis, VO, Lin, PP, Cannon, CP, Zagars, GK, Pollock, RE & Pisters, PWT 2006, 'The effect of preoperative radiotherapy and reconstructive surgery on wound complications after resection of extremity soft-tissue sarcomas', Annals of Surgical Oncology, vol. 13, no. 9, pp. 1209-1215. https://doi.org/10.1245/s10434-006-9028-6
Tseng, Jennifer F. ; Ballo, Matthew ; Langstein, Howard N. ; Wayne, Jeffrey D. ; Cormier, Janice N. ; Hunt, Kelly K. ; Feig, Barry W. ; Yasko, Alan W. ; Lewis, Valerae O. ; Lin, Patrick P. ; Cannon, Christopher P. ; Zagars, Gunar K. ; Pollock, Raphael E. ; Pisters, Peter W.T. / The effect of preoperative radiotherapy and reconstructive surgery on wound complications after resection of extremity soft-tissue sarcomas. In: Annals of Surgical Oncology. 2006 ; Vol. 13, No. 9. pp. 1209-1215.
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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. Published by Springer Science+Business Media, Inc.",
author = "Tseng, {Jennifer F.} and Matthew Ballo and Langstein, {Howard N.} and Wayne, {Jeffrey D.} and Cormier, {Janice N.} and Hunt, {Kelly K.} and Feig, {Barry W.} and Yasko, {Alan W.} and Lewis, {Valerae O.} and Lin, {Patrick P.} and Cannon, {Christopher P.} and Zagars, {Gunar K.} and Pollock, {Raphael E.} and Pisters, {Peter W.T.}",
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T1 - The effect of preoperative radiotherapy and reconstructive surgery on wound complications after resection of extremity soft-tissue sarcomas

AU - Tseng, Jennifer F.

AU - Ballo, Matthew

AU - Langstein, Howard N.

AU - Wayne, Jeffrey D.

AU - Cormier, Janice N.

AU - Hunt, Kelly K.

AU - Feig, Barry W.

AU - Yasko, Alan W.

AU - Lewis, Valerae O.

AU - Lin, Patrick P.

AU - Cannon, Christopher P.

AU - Zagars, Gunar K.

AU - Pollock, Raphael E.

AU - Pisters, Peter W.T.

PY - 2006/9/1

Y1 - 2006/9/1

N2 - 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. Published by Springer Science+Business Media, Inc.

AB - 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. Published by Springer Science+Business Media, Inc.

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