Nonmetastatic Nonrhabdomyosarcoma Soft Tissue Sarcoma

This is Todd Ponsky with the Journal of Pediatric Surgery, and here's your two-minute review. Today we're reviewing a paper called Re-excision after Unplanned resection of non-metastatic non-rhabdomyosarcoma, soft tissue sarcoma. First author is Doctor Qureshi. What they tried to ascertain in this paper was, is there a difference in outcome in patients that were thought to have non-rhabdosarcoma that had a planned workup and excision versus those that had innocuous lesions that were not thought to be non-rhabdosarcoma were just denucleated or excised, and then they got the results back which showed non-rhabdosarcoma and went for a re. So they wanted to compare the outcome in those two groups. So the way they did the study is they took patients that were sent to them. There were 40 patients sent to them that had, had an innocuous lesion removed that came back as non-rhabdosarcoma, and they were sent to them for possible re-excision. Of those, 5 were deemed impossible to do a re-excision for a multitude of reasons based on location or for whatever reason that left 35 patients. That they took for re-excision after having the primary excision that compared to the patients that they saw at their hospital in which they had a planned excision. They did a workup such as MRI or incisional biopsy or core biopsy and then did a planned wide local excision, and there were 44 in that group that they had at their hospital. Of the 44, 23. Had neoadjuvant therapy that left 21 patients that had a workup were found to have non-rhabdosarcoma and went for a wide local excision. So what they did is they compared these two groups. And here's what they found. When looking at the unplanned to the planned excision patients, so the first thing they looked at was residual tumor, and what was fascinating is they actually found that 45.7% of the patients that they did the re-excision on actually had residual tumor. But then they looked at outcomes and they found that in disease relapse there was no difference between the planned or unplanned excision. In 5 year overall survival, there was no difference between unplanned or planned excision. Disease free survival, no difference between the two groups, and local control rates or local recurrence, no difference between the two groups. So what the conclusions were, what they found was that number one, That patients that you take out a lesion and not suspecting it's non rhabdosarcoma and it comes back to be and they go for re-excision, almost half of them have residual tumor, but there was no outcome difference between those patients and those that had a planned excision. So their conclusion was patients should have a higher index of suspicion and should be worked up more thoroughly. I have a, a different conclusion and, and many of you may disagree, so I'd love to see your comments below. I'm thinking about all the patients that weren't mentioned here that had an excision or a nucleation of a benign looking lesion that wasn't non rhabdosarcoma. How many of those patients were spared from a full workup such as MRI or incisional biopsy or core biopsy? So I, I think that since there's no outcome difference, it seems to me that it's probably OK with a low index of suspicion to excise the lesion and if it comes back as non-rhabdosarcoma, then do a re-excision. Some would argue though that there might be a high morbidity to a re-excision sometimes because uh you have to take a lot more tissue. So I'd love to hear your comments below. Thank you and we'll see you next time.