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Poster Discussion – Sarcoma

2818 - Improved survival with secondary surgery in a reference center after a first R1 or R2 resection in soft tissue sarcoma (STS) of the limbs or trunk wall: an analysis 10931 patients (pts) in NETSARC.


28 Sep 2019


Poster Discussion – Sarcoma


Francois Gouin


Annals of Oncology (2019) 30 (suppl_5): v683-v709. 10.1093/annonc/mdz283


F. Gouin1, E. Stoeckle2, S. BONVALOT3, C. Honoré4, A. Decanter5, P. Anract6, E. Bompas7, G. Ferron8, F. Sirveaux9, A. Rochwerger10, S. Carrere11, A. Di Marco12, M. Ropars13, L. Le Nail14, O. Marco15, J. Guiramand16, A. Italiano17, N. Penel18, A. Le Cesne19, J. Blay20

Author affiliations

  • 1 Oncologic Surgery, Centre Léon Bérard, 69008 - Lyon/FR
  • 2 Oncologic Surgery, Institut Bergonié, 33076 - Bordeaux/FR
  • 3 Oncologic Surgery, Institut Curie, 75005 - Paris/FR
  • 4 Oncologic Surgery, Gustave Roussy - Cancer Campus, 94805 - Villejuif/FR
  • 5 Oncologic Surgery, Centre Oscar Lambret, 59020 - Lille/FR
  • 6 Oncologic Surgery, Hopital cochin, 75014 - Paris/FR
  • 7 Medical Oncology, ICO Institut de Cancerologie de l'Ouest René Gauducheau, 44805 - Saint-Herblain/FR
  • 8 Oncologic Surgery, Institut Universitaire du Cancer -Toulouse- Oncopole, 31059 - Toulouse/FR
  • 9 Oncologic Surgery, Centre chirurgical Emile Gallé, 54000 - Nancy/FR
  • 10 Orthopedic Surgery, Hopital Nord Marseille, 13915 - Marseille/FR
  • 11 Oncologic Surgery, Institut du Cancer de Montpellier, 34298 - Montpellier/FR
  • 12 Oncologic Surgery, Hopital de hautepierre, 67200 - Strasbourg/FR
  • 13 Orthopedic Surgery, CHU Pontchaillou, 35000 - Rennes/FR
  • 14 Orthopedic Surgery, Hôpital Trousseau, 37044 - Tours/FR
  • 15 Plastic Surgery, Hôpital Saint Louis, 75010 - Paris/FR
  • 16 Oncologic Surgery, guiramandj@ipc.unicancer.fr), Chirurgie oncologique, Institut Paoli Calmettes, 232 boulevard de Sainte Marguerite, 13009 Marseille,, 13009 - Marseille/FR
  • 17 Early Phase Trials Unit, Institute Bergonié, 33076 - Bordeaux/FR
  • 18 General Oncology Department, Centre Oscar Lambret, 59020 - Lille/FR
  • 19 Département De Médecine Oncologique, Institut Gustave Roussy, 94805 - Villejuif/FR
  • 20 Medical Oncology, Centre Léon Bérard, 69008 - Lyon/FR


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Abstract 2818


We investigated the impact of secondary surgery (2Surg) after a first R1 or R2 resection in the 10931 pts with STS of the limb or trunk wall included in the nationwide NETSARC database from 2010 to 2017.


NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDT), funded by the French NCI (INCa). Since 2010, presentation to an MDTB and second pathological review are mandatory for sarcoma pts. Statistics were performed with SPSS23.0. LRFS, metastasis-free survival (MFS), OS compared with the logrank test.


In 5295 (49.4%) patients, sarcoma were located on the lower limb, 3670 (33.6%) on trunk wall, 1966 (18.0%) on upper limb. Local RFS (LRFS) and RFS (p < 0.001), but not OS, were superior for pts operated in a NETSARC center (N = 4417, 41%). LRFS & OS were best for pts presented to a Netsarc MDT (NMDT) AND who were first operated in NETSARC centers; while the worst LRFS & OS were observed in pts presented in a NMDT but first operated outside a NetSARC center (p < 0.001). Among the 2081 pts with a first R1 resection in whom 2Surg was documented, 1047 (50.3%) were reoperated. These R1 reoperated pts had a superior LRFS, metastatic free survival (MFS) and OS (p < 0.001): LRFS (p < 0.001), MFS (p = 0.05) and OS (p < 0.001) were superior after 2Surg only in pts operated 1st outside a Netsarc center. There were 823 pts with a first surgery with R2 resection in whom 2Surg was documented: 619 (75.2%) were reoperated. R2 reoperated patients had a superior LRFS and OS (p = 0.01). MFS was not different. Again, LRFS (p < 0.001) & OS (p < 0.001) were superior after 2Surg only in pts operated 1st outside a Netsarc center. Among reoperated pts, those for whom 2Surg was in a NetSARC center had a superior LRFS & RFS (p < 0.001) and OS (p = 0.05).


In this nationwide series of limb or trunk wall STS, 2Surg after a R1 or R2 primary excision was associated with an improved OS only when pts had been operated first outside a reference center. 2Surg in a NETSARC center was associated with a better OS.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Jean-Yves Blay.


INCA (NetSarc, RREPS, RESOS, LYRICAN (INCA-DGOS-INSERM 12563), ARC fundation, Ligue de L’Ain contre le Cancer, INCA (NetSARC, RREPS, RESOS and LYRICAN (INCA-DGOS-INSERM 12563), InterSARC), La Ligue contre le Cancer, Ligue de L’Ain contre le Cancer, la Fondation ARC, EURACAN (EC 739521).


All authors have declared no conflicts of interest.

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