Abstract 49P
Background
Extremity soft tissue sarcomas are rare neoplasms. Because these tumors are usually pseudo-capsulated, many practices are initially thought to be benign and are excised without a proper preoperative imaging, biopsy, or planning by an unwary surgeon. These excisions have termed “Whoops! Procedure” indicating the surprise and distress that the surgeon experiences, after the pathologist reports a malignant neoplasm in a postoperative specimen. We aimed at studying the oncological outcomes of patients undergoing unplanned (whoops) excision for soft-tissue sarcomas (STS) at a tertiary cancer institute.
Methods
This was a retrospective analysis of patients of STS of trunk and extremity from 2017 to 2021. we compared patients who had undergone ‘whoops’ surgery with or without re-surgery versus patients had undergone wide local excision WLE for the oncological outcomes, including overall survival (OS) and disease-free survival (DFS).
Results
After excluding patients with gross residual (R2) and incomplete medical data, Sixty-nine patients were included with median age of 44, patients were divided into two groups: group 1 included 44(63.7%) who underwent whoops surgery and group 2 included 25 (36.3%) underwent WLE. The median follow-up period was 39.6 months. Group 1 were more likely to have smaller tumors (T1-2) 31 patients (70.4%) vs 9 patients (36%) in group 2. Considering margin; R0 was achieved in 4 patients (9.5%) and R1 in 38 patients (90.5%) in group 1 vs R0 in 17 patients (68%) and R1 in 8 patients (32%) in group 2. There were 9 (20.5%) local recurrences in group 1 and 3 (12%) in group 2 (P=0.411). There was no difference in DFS and OS in both groups. The median DFS in group 1 was 21.3 months vs 32.3 months in group 2 (p=0.414), the median OS was 42 months in group 1 vs 38.5 months in group 2 (p=0.974). There was no significant difference in local recurrence in the whoops group between patients who underwent re-excision or not. Also there was no difference in median DFS in re-resection group which was 7.7 months vs 27.5 months in patients who had not undergone re-resection (p=0.06).
Conclusions
Although local recurrence is much more common in the whoops surgery group, re-resection does not seem to affect DFS or OS.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.