Carolina Curioni, Tim Pruimboom, Robert JCMF de Kleijn, Christel Meers-Haekens, Frederik WK Wesseling, Kristien Keymeulen, Marc HA Bemelmans, Shan Shan Qiu and Sanne M. E. Engelen*
Background: The treatment of high-grade soft tissue sarcoma of the extremities and abdominal/trunk wall requires neoadjuvant radiotherapy followed by surgical resection. Neoadjuvant Radiotherapy (RTx) may result in closer resection margins and a more function-preserving approach. However, radiotherapy has a detrimental effect on tissue vascularization, leading to a higher incidence of Postoperative Wound Complications (PWC). Wound complications can increase morbidity, decrease quality of life and may require additional interventions. In this study we examine the postoperative wound complication rate in patients who underwent sarcoma resection in Maastricht University Medical Center (MUMC+) in the past ten years. Moreover, we aim to determine the effect of neoadjuvant radiotherapy and Plastic Surgical Reconstruction (PSR) on wound complications. Methods: 260 patients who underwent soft tissue sarcoma resection at our center between 2014 and 2023 were retrospectively analyzed. The total wound complication rate was recorded per complication, and the patient cohort was subdivided into groups of patients who received neoadjuvant radiotherapy or not and/or plastic surgical reconstruction or not. Wound complications were scored as no wound complications, Minor Wound Complication (MiWC) and major wound complication (MaWC). Results: Postoperative wound complications were recorded in 44.6% of patients, including infection (23%), wound dehiscence (17%), seroma (13%), and skin necrosis (8%). Neoadjuvant radiotherapy and plastic surgical reconstruction were both associated with an increased overall wound complication incidence (OR: 3.75, 95% CI: 2.08–6.74, p<0.001 and OR: 1.85, 95% CI: 1.05–3.28, p=0.034, respectively). In the radiotherapy group, infection was the most prevalent complication (OR: 2.78, p=0.004). The patients in the plastic surgical reconstruction group experienced predominantly minor wound complications. Dehiscence was the most prevalent complication in this group of patients (OR: 3.48, p=0.002). Conclusion: This study showed that neoadjuvant radiotherapy and plastic surgical reconstruction for sarcoma patients are both associated with an increase in wound complication rate. Plastic surgical reconstruction was predominantly associated to minor complications. Future studies should focus on lowering the wound complication rates and improving care for sarcoma patients.
Archives of Surgical Oncology received 37 citations as per Google Scholar report
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