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A Comparative Analysis of Clinical and Efficiency Outcomes: Evaluating Orthopedic Oncologic vs. Integrated Orthoplastic Oncologic Approach in Sarcoma treatment at OSU Wexner Medical Center
Athena Zhang MD; David Nash MD; Fode Tounkara PhD; Gunel Guliyeva MD; Jason M Souza MD
The Ohio State University Wexner Medical Center (OSUWMC)
2024-02-01
Presenter: Athena Zhang
Affidavit:
Certified
Director Name: Jason M Souza
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: Recent advances in soft-tissue sarcoma (STS) treatment have instigated ongoing discussions on optimal surgical approaches. This study aims to assess the clinical efficacy and efficiency of two distinct approaches-orthopedic oncologic and integrated orthoplastic oncologic-for STS treatment at OSUWMC.
Method: A retrospective study was conducted on patients with truncal/lower extremity STS who underwent primary resection by an orthopedic oncologic surgeon at OSUWMC between 2018 and 2023.
Results: Out of 143 patients with truncal/lower extremity STS resected by an orthopedic oncologic surgeon, 74 underwent closure by orthopedics, while 69 received wound closure by reconstructive plastic surgeons. Both approaches included sarcomas in similar regions, notably 4.2% trunk, 69.9% proximal lower extremity, 25.9% distal lower extremity. Median maximum tumor diameter (MTD) was 5.6cm vs 9.5cm for orthopedic vs orthoplastic respectively. Univariate regression demonstrated the following independent risk factors for complications requiring re-operation: MTD ≥5 to <10 cm [OR= 3.7, (1.32-12.2), p=0.019], MTD ≥ 10 cm [OR= 3.58, (1.23-12), p=0.025], radiotherapy [OR=3.54, (1.58-8.61), p=0.003], chemotherapy [OR= 2.82, (1.33-6.15), p=0.008], longest 25% OR duration [OR= 8.63, (1.66-159), p=0.04], and initial length of stay >7 days [OR= 2.81, (1.18-6.96), p=0.022]. Preoperative and intraoperative radiation were associated with an increased risk of unplanned 90-day readmission [OR= 2.24, (1.06-4.91), p=0.038]. Radiation was identified as an independent risk factor for any postoperative wound complication [OR= 2.48, (1.14-5.55), p=0.024] regardless of tumor size and the type of wound closure approach.
Conclusion: Radiation emerges as a strong predictor of outcome measures in STS management regardless of the surgical approach.
