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Dr. Todd Ponsky

Pediatric Surgery · View profile →

Nonmetastatic Nonrhabdomyosarcoma Soft Tissue Sarcoma

Video Published 2018-09-14 Updated 2026-02-12

Timestops (3)

Study Design and Patient Selection

Comparing Planned vs Unplanned Excision Outcomes

Clinical Implications and Recommendations

Topic Overview

A single-speaker review of a study comparing outcomes between planned wide excision and unplanned excision followed by re-excision for non-metastatic non-rhabdomyosarcoma soft tissue sarcoma. The study found 45.7% residual tumor at re-excision after unplanned removal, yet no difference in disease relapse, 5-year overall survival, disease-free survival, or local recurrence between the two groups. The reviewer questions whether routine pre-operative workup is necessary given equivalent outcomes, though acknowledges potential re-excision morbidity.

Key Takeaways

45.7% of unplanned excisions had residual tumor at re-excision, yet outcomes matched planned wide excision. (1:56)
No difference in 5-year survival, disease-free survival, or local recurrence between planned vs unplanned excision. (2:21)
Re-excision after unplanned removal may be acceptable approach, though it can require more extensive tissue removal. (3:26)

Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

Todd Ponsky — host

Chapters

0:00Study Introduction and Question — Introduction to a paper by Dr. Qureshi comparing outcomes between planned excision versus unplanned excision with re-excision for non-rhabdomyosarcoma soft tissue sarcoma.
0:44Study Design and Patient Groups — Description of two patient cohorts: 35 patients who had unplanned excision of innocuous lesions followed by re-excision, and 21 patients who had planned wide local excision after workup.
1:53Study Findings — Results showing 45.7% residual tumor at re-excision, but no difference between groups in disease relapse, 5-year overall survival, disease-free survival, or local recurrence.
2:56Interpretation and Commentary — Discussion of study conclusions versus reviewer's alternative interpretation that unplanned excision may be acceptable given equivalent outcomes, with acknowledgment of potential re-excision morbidity.

Key claims

0:4940 patients were referred after having an innocuous lesion removed that came back as non-rhabdomyosarcoma — Todd Ponsky
1:005 of the 40 referred patients were deemed impossible to re-excise based on location or other reasons — Todd Ponsky
1:0035 patients underwent re-excision after unplanned primary excision — Todd Ponsky
1:1044 patients had planned excision at the study hospital after workup with MRI or incisional biopsy or core biopsy — Todd Ponsky
1:3323 of the 44 planned excision patients received neoadjuvant therapy — Todd Ponsky
1:3821 patients had workup followed by planned wide local excision without neoadjuvant therapy — Todd Ponsky
1:5645.7% of patients who underwent re-excision had residual tumor — Todd Ponsky
2:13There was no difference in disease relapse between planned and unplanned excision groups — Todd Ponsky
2:21There was no difference in 5-year overall survival between planned and unplanned excision groups — Todd Ponsky
2:26There was no difference in disease-free survival between planned and unplanned excision groups — Todd Ponsky
2:26There was no difference in local control rates or local recurrence between planned and unplanned excision groups — Todd Ponsky
2:56The study authors concluded that patients should have a higher index of suspicion and should be worked up more thoroughly — Todd Ponsky
3:26Since there is no outcome difference, it may be acceptable with low index of suspicion to excise the lesion and do re-excision if it comes back as non-rhabdomyosarcoma — Todd Ponsky
3:39Re-excision sometimes has high morbidity because you have to take a lot more tissue — Todd Ponsky

Points of disagreement

2:56Whether routine pre-operative workup is necessary for suspicious lesions
- Todd Ponsky: Study authors recommend higher index of suspicion and thorough workup before excision
- Todd Ponsky: Reviewer suggests unplanned excision followed by re-excision if needed may be acceptable given equivalent outcomes and sparing many patients with benign lesions from extensive workup

Open questions

How many patients with benign-appearing lesions would require unnecessary workup to prevent re-excision in the subset that are sarcoma?
What is the actual morbidity difference between planned wide excision versus unplanned excision followed by re-excision?
Are there specific clinical or imaging features that could better stratify which lesions warrant pre-operative workup?

This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Keywords

non-rhabdomyosarcoma soft tissue sarcoma non-metastatic non-rhabdomyosarcoma re-excision wide local excision enucleation MRI incisional biopsy core biopsy neoadjuvant therapy Journal of Pediatric Surgery

Hashtags

#PediatricSurgery #SoftTissueSarcoma #SurgicalOncology #TumorResection #NeoadjuvantTherapy #SurgicalOutcomes #CancerResearch #Oncology #Surgery #MedicalEducation #PatientCare #SurgicalTechniques #TumorManagement #Healthcare #SurgicalMorbidity #ClinicalTrials #SurgicalPathology #LesionManagement #DiseaseSurvival #TumorRecurrence #PediatricOncology #NRSTS

Transcript

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.

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