Arch Hand Microsurg.  2022 Dec;27(4):336-344. 10.12790/ahm.22.0064.

Association of inflammatory complications following resection and immediate reconstruction with soft tissue sarcoma recurrence

• Kim J
• Mun GH
• Seo SW
• Lee KT

• KMID: 2536222
• DOI: http://doi.org/10.12790/ahm.22.0064

Abstract

Purpose
Wide excision and subsequent reconstruction of the defect are crucial pillars in the treatment of soft tissue sarcoma (STS); however, those procedures carry a relatively high risk of postoperative complications, which could raise oncologic concerns. The present study evaluated the association of postoperative complications after resection and immediate reconstruction with STS recurrence.
Methods
We reviewed patients with primary STS who underwent wide resection and immediate reconstruction between 2011 and 2019. Patients were categorized into three groups based on their postoperative inflammatory complication status: no complications, noninflammatory complications, and inflammatory complications. Inflammatory complications were defined as those involving a sustained elevation of inflammatory markers in laboratory tests after postoperative 2 weeks. The cumulative incidence of oncologic events and their respective hazard ratios (HRs) were evaluated using multivariable Cox regression analyses.
Results
In total, 94 patients with a median follow-up of 54.8 months were analyzed, including 17 with inflammatory complications, 17 with noninflammatory complications, and 60 with no complications. The three groups showed similar baseline characteristics except for older age and a lower rate of FNCLCC (Fédération Nationale des Centres de Lutte Contre Le Cancer) grade 3 in the inflammatory complications group. The inflammatory complications group showed significantly worse disease-free survival than the no complications group. This difference remained significant after adjustment for other variables in multivariate analyses (HR, 3.485; p=0.019). The development of noninflammatory complications was not associated with oncologic outcomes.
Conclusion
Our findings suggest that the development of inflammatory complications following wide excision and immediate reconstruction may be associated with the recurrence of STS.

Keyword

Soft tissue sarcoma; Reconstruction; Inflammatory complication

Figure

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  Fig. 1. Disease-free survival according to the development of postoperative inflammatory complications (Cx).

Reference

References

1. Gamboa AC, Gronchi A, Cardona K. Soft-tissue sarcoma in adults: an update on the current state of histiotype-specific management in an era of personalized medicine. CA Cancer J Clin. 2020; 70:200–29.

2. Choi JH, Ro JY. The 2020 WHO classification of tumors of soft tissue: selected changes and new entities. Adv Anat Pathol. 2021; 28:44–58.

3. Götzl R, Sterzinger S, Arkudas A, et al. The role of plastic reconstructive surgery in surgical therapy of soft tissue sarcomas. Cancers (Basel). 2020; 12:3534.

4. Pucher PH, Aggarwal R, Qurashi M, Darzi A. Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival. Br J Surg. 2014; 101:1499–508.

5. Katoh H, Yamashita K, Wang G, Sato T, Nakamura T, Watanabe M. Anastomotic leakage contributes to the risk for systemic recurrence in stage II colorectal cancer. J Gastrointest Surg. 2011; 15:120–9.

6. Beecher SM, OʼLeary DP, McLaughlin R, Kerin MJ. The impact of surgical complications on cancer recurrence rates: a literature review. Oncol Res Treat. 2018; 41:478–82.

7. Lee KT, Jung JH, Mun GH, et al. Influence of complications following total mastectomy and immediate reconstruction on breast cancer recurrence. Br J Surg. 2020; 107:1154–62.

8. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002; 420:860–7.

9. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008; 454:436–44.

10. Matsubara D, Arita T, Nakanishi M, et al. The impact of postoperative inflammation on recurrence in patients with colorectal cancer. Int J Clin Oncol. 2020; 25:602–13.

11. Salvans S, Mayol X, Alonso S, et al. Postoperative peritoneal infection enhances migration and invasion capacities of tumor cells in vitro: an insight into the association between anastomotic leak and recurrence after surgery for colorectal cancer. Ann Surg. 2014; 260:939–44.

12. Behnke NK, Alamanda VK, Song Y, et al. Does postoperative infection after soft tissue sarcoma resection affect oncologic outcomes? J Surg Oncol. 2014; 109:415–20.

13. Broecker JS, Ethun CG, Monson DK, et al. The oncologic impact of postoperative complications following resection of truncal and extremity soft tissue sarcomas. Ann Surg Oncol. 2017; 24:3574–86.

14. Dadras M, Koepp P, Wallner C, et al. Wound complications are a predictor of worse oncologic outcome in extremity soft tissue sarcomas. Surg Oncol. 2020; 33:126–34.

15. Callegaro D, Miceli R, Bonvalot S, et al. Development and external validation of two nomograms to predict overall survival and occurrence of distant metastases in adults after surgical resection of localised soft-tissue sarcomas of the extremities: a retrospective analysis. Lancet Oncol. 2016; 17:671–80.

16. Kurokawa Y, Yamashita K, Kawabata R, et al. Prognostic value of postoperative C-reactive protein elevation versus complication occurrence: a multicenter validation study. Gastric Cancer. 2020; 23:937–43.

17. Saito T, Kurokawa Y, Miyazaki Y, et al. Which is a more reliable indicator of survival after gastric cancer surgery: Postoperative complication occurrence or C-reactive protein elevation? J Surg Oncol. 2015; 112:894–9.

18. Hou T, Guo T, Nie R, et al. The prognostic role of the preoperative systemic immune-inflammation index and high-sensitivity modified Glasgow prognostic score in patients after radical operation for soft tissue sarcoma. Eur J Surg Oncol. 2020; 46:1496–502.

19. Morhij R, Mahendra A, Jane M, McMillan DC. The modified Glasgow prognostic score in patients undergoing surgery for bone and soft tissue sarcoma. J Plast Reconstr Aesthet Surg. 2017; 70:618–24.

20. Li Y, Liu X, Zhang J, Yao W. Prognostic role of elevated preoperative systemic inflammatory markers in localized soft tissue sarcoma. Cancer Biomark. 2016; 16:333–42.