Patterns of major wound complications following multidisciplinary therapy for lower extremity soft tissue sarcoma

• Published in: Journal of surgical oncology Vol. 114; no. 3; pp. 385 - 391
• Main Authors: Miller, Eric D., Mo, Xiaokui, Andonian, Nicole T., Haglund, Karl E., Martin, Douglas D., Liebner, David A., Chen, James L., Iwenofu, Obiajulu H., Chakravarti, Arnab, Scharschmidt, Thomas J., Mayerson, Joel L., Pollock, Raphael E., Xu-Welliver, Meng
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-09-2016; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Female; Humans; Lower Extremity; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - pathology; Postoperative Complications - therapy; radiotherapy; Retrospective Studies; Risk Factors; sarcoma; Sarcoma - mortality; Sarcoma - therapy; Soft Tissue Neoplasms - mortality; Soft Tissue Neoplasms - therapy; Time Factors; Treatment Outcome; wounds and injuries; Young Adult; radiotherapy; wounds and injuries; sarcoma; lower extremity
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24313

Background and Objectives
The purpose of this study was to determine the pattern and timing of major wound complications (MWCs) in patients at our institution who received multimodality treatment for lower extremity soft tissue sarcoma (LE‐STS) and to evaluate the impact of MWCs on tumor control and patient outcomes.
Methods
The medical records of 102 LE‐STS patients treated with limb‐sparing surgery and radiation therapy were reviewed. MWCs were defined as secondary operations with anesthesia, seroma/hematoma aspiration, admission for IV antibiotics, or persistent deep packing.
Results
MWCs occurred in 22% of patients, with 45% of events occurring >120 days after resection. On multivariate analysis, preoperative external beam radiation therapy (EBRT) (OR 4.29, 95% CI 1.06–17.40, P = 0.042) and skin graft placement (OR 6.39, 95% CI 1.37–29.84, P = 0.018) were found to be independent predictors of MWCs. MWC occurrence did not predict for chronic toxicity and did not impact tumor control or survival.
Conclusions
A considerable proportion of MWCs occur >120 days from surgical resection with preoperative EBRT and skin graft placement independent predictors for MWCs. While an additional source of morbidity, MWC occurrence did not impact tumor control, nor did it predict for chronic toxicity. J. Surg. Oncol. 2016;114:385–391. © 2016 Wiley Periodicals, Inc.