The importance of clear margins in myxofibrosarcoma: Improving local control by means of staged resection and reconstruction |
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| Affiliation: | 1. The North of England Bone and Soft Tissue Tumour Service, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom;2. Kellogg College, University of Oxford. Oxford, United Kingdom;1. Department of Pathology and Molecular Medicine, Queen''s University, 88 Stuart Street, Kingston, Ontario, K7L 3N6, Canada;2. Department of Radiology, MD Anderson Cancer Center, C. de Arturo Soria, 270, 28033, Madrid, Spain;3. Department of Surgery, Queen''s University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada;4. School of Computing, Queen''s University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada;5. Department of Surgery, University Health Network and Princess Margaret Hospital, University of Toronto, 610 University Ave, Toronto, Ontario M5G 2M9, Canada;1. Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Stanmore, UK;2. Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK;1. Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy;2. Student in Erasmus Exchange Programme, Faculty of Medicine, Sapienza University of Rome, Rome, Italy;3. Department of Public Health, Federico II University, Naples, Italy;4. Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Ghent, Belgium;1. Ospedale Sant’Andrea, Sapienza University of Rome, Roma, Italy;2. ‘Regina Elena’ National Cancer Institute, Department of Urology, Rome, Italy;3. University of Southern California, Department of Urology, Los Angeles, USA;4. Mansoura University, Department of Urology, Mansoura, Egypt;5. Policlinico Umberto Io, Sapienza University of Rome, Roma, Italy |
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| Abstract: | IntroductionMyxofibrosarcomas are associated with a locally infiltrative growth pattern, making a clear-margin resection margin challenging. This leads to high local recurrence rates. While immediate wound closure and adjuvant radiotherapy has been proposed to mitigate incomplete excisions, we present our experience treating myxofibrosarcomas with staged excisions until clear margins are obtained, prior to reconstruction.MethodsAll patients with myxofibrosarcomas treated with a curative intent at our centre between 2009 and 2019 were identified. Patient demographics, tumour characteristics, number of resections, method of reconstruction, adjuvant therapy, complications, local recurrence rates, length of hospital stay and overall survival were assessed.Results97 consecutive eligible patients were identified. Forty-six (47%) had positive margins reported following a first resection. The median number of resections required to obtain clear margins was two and the median time from first excision to definitive wound closure was 15 days. Local recurrence rate for the whole cohort was 14%. Patients who had staged resection until clear margins were obtained had a significantly lower rate of local recurrence compared to those who had positive margins at time of reconstruction (p-value = 0.001). The estimated 5-year disease-specific survival for the whole cohort was 93%.DiscussionObtaining clear margins in myxofibrosarcoma via staged resections was associated with lower local recurrence rates for patients who had an initial resection with positive margins. The outcomes of performing staged resections are equivalent to patients for whom a clear margin were obtained in the first instance. |
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