The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany—Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa)
Although the involvement of plastic surgery has been deemed important in the treatment of sarcoma patients to avoid oncological compromises and ameliorate patient outcomes, it is not ubiquitously available. The accessibility of defect reconstruction and its therapeutic impact on sarcoma care is the...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-09-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/17/4312 |
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| author | Benjamin Thomas Amir K. Bigdeli Steffen Nolte Emre Gazyakan Leila Harhaus Oliver Bischel Burkhard Lehner Gerlinde Egerer Gunhild Mechtersheimer Peter Hohenberger Raymund E. Horch Dimosthenis Andreou Jochen Schmitt Markus K. Schuler Martin Eichler Ulrich Kneser |
| author_facet | Benjamin Thomas Amir K. Bigdeli Steffen Nolte Emre Gazyakan Leila Harhaus Oliver Bischel Burkhard Lehner Gerlinde Egerer Gunhild Mechtersheimer Peter Hohenberger Raymund E. Horch Dimosthenis Andreou Jochen Schmitt Markus K. Schuler Martin Eichler Ulrich Kneser |
| author_sort | Benjamin Thomas |
| collection | DOAJ |
| description | Although the involvement of plastic surgery has been deemed important in the treatment of sarcoma patients to avoid oncological compromises and ameliorate patient outcomes, it is not ubiquitously available. The accessibility of defect reconstruction and its therapeutic impact on sarcoma care is the subject of this analysis. Cross-sectional data from 1309 sarcoma patients were collected electronically at 39 German study centers from 2017 to 2019. A total of 621 patients with surgical treatment for non-visceral soft-tissue sarcomas were included. The associated factors were analyzed exploratively using multifactorial logistic regression to identify independent predictors of successful defect reconstruction, as well Chi-squared and Cochran–Mantel–Haenszel tests to evaluate subgroups, including limb-salvage rates in extremity cases. A total of 76 patients received reconstructive surgery, including 52 local/pedicled versus 24 free flaps. Sarcomas with positive margins upon first resection (OR = 2.3, 95%CI = 1.2–4.4) that were excised at centers with lower degrees of specialization (OR = 2.2, 95%CI = 1.2–4.2) were independently associated with the need for post-oncological defect coverage. In this context, the inhouse availability of plastic surgery (OR = 3.0, 95%CI = 1.6–5.5) was the strongest independent predictor for successful flap-based reconstruction, which in turn was associated with significantly higher limb-salvage rates (OR = 1.4, 95%CI = 1.0–2.1) in cases of extremity sarcomas (<i>n</i> = 366, 59%). In conclusion, consistent referral to specialized interdisciplinary sarcoma centers significantly ameliorates patient outcomes by achieving higher rates of complete resections and offering unrestricted access to plastic surgery. The latter in particular proved indispensable for limb salvage through flap-based defect reconstruction after sarcoma resection. In fact, although there remains a scarcity of readily available reconstructive surgery services within the current sarcoma treatment system in Germany, plastic and reconstructive flap transfer was associated with significantly increased limb-salvage rates in our cohort. |
| first_indexed | 2024-03-10T01:58:05Z |
| format | Article |
| id | doaj.art-9e470ef65d0640f098e941aec8f22774 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T01:58:05Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-9e470ef65d0640f098e941aec8f227742023-11-23T12:53:28ZengMDPI AGCancers2072-66942022-09-011417431210.3390/cancers14174312The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany—Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa)Benjamin Thomas0Amir K. Bigdeli1Steffen Nolte2Emre Gazyakan3Leila Harhaus4Oliver Bischel5Burkhard Lehner6Gerlinde Egerer7Gunhild Mechtersheimer8Peter Hohenberger9Raymund E. Horch10Dimosthenis Andreou11Jochen Schmitt12Markus K. Schuler13Martin Eichler14Ulrich Kneser15Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, GermanyDepartment of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, GermanyDepartment of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, GermanyDepartment of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, GermanyDepartment of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, GermanyDepartment of Trauma and Orthopedics, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen, GermanyDepartment of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, 69118 Heidelberg, GermanyDepartment of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, GermanyInstitute of Pathology, Heidelberg University Hospital, 69120 Heidelberg, GermanyDivision of Surgical Oncology, Department of Surgery, Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, GermanyDepartment of Plastic and Hand Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, GermanyDepartment of General Orthopedics and Tumor Orthopedics, University Hospital Münster, 48149 Münster, GermanyNational Center for Tumor Diseases (NCT/UCC), 01307 Dresden, GermanyClinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, GermanyNational Center for Tumor Diseases (NCT/UCC), 01307 Dresden, GermanyDepartment of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, GermanyAlthough the involvement of plastic surgery has been deemed important in the treatment of sarcoma patients to avoid oncological compromises and ameliorate patient outcomes, it is not ubiquitously available. The accessibility of defect reconstruction and its therapeutic impact on sarcoma care is the subject of this analysis. Cross-sectional data from 1309 sarcoma patients were collected electronically at 39 German study centers from 2017 to 2019. A total of 621 patients with surgical treatment for non-visceral soft-tissue sarcomas were included. The associated factors were analyzed exploratively using multifactorial logistic regression to identify independent predictors of successful defect reconstruction, as well Chi-squared and Cochran–Mantel–Haenszel tests to evaluate subgroups, including limb-salvage rates in extremity cases. A total of 76 patients received reconstructive surgery, including 52 local/pedicled versus 24 free flaps. Sarcomas with positive margins upon first resection (OR = 2.3, 95%CI = 1.2–4.4) that were excised at centers with lower degrees of specialization (OR = 2.2, 95%CI = 1.2–4.2) were independently associated with the need for post-oncological defect coverage. In this context, the inhouse availability of plastic surgery (OR = 3.0, 95%CI = 1.6–5.5) was the strongest independent predictor for successful flap-based reconstruction, which in turn was associated with significantly higher limb-salvage rates (OR = 1.4, 95%CI = 1.0–2.1) in cases of extremity sarcomas (<i>n</i> = 366, 59%). In conclusion, consistent referral to specialized interdisciplinary sarcoma centers significantly ameliorates patient outcomes by achieving higher rates of complete resections and offering unrestricted access to plastic surgery. The latter in particular proved indispensable for limb salvage through flap-based defect reconstruction after sarcoma resection. In fact, although there remains a scarcity of readily available reconstructive surgery services within the current sarcoma treatment system in Germany, plastic and reconstructive flap transfer was associated with significantly increased limb-salvage rates in our cohort.https://www.mdpi.com/2072-6694/14/17/4312sarcomadefectreconstructionmicrosurgeryreconstructive surgeryplastic surgery |
| spellingShingle | Benjamin Thomas Amir K. Bigdeli Steffen Nolte Emre Gazyakan Leila Harhaus Oliver Bischel Burkhard Lehner Gerlinde Egerer Gunhild Mechtersheimer Peter Hohenberger Raymund E. Horch Dimosthenis Andreou Jochen Schmitt Markus K. Schuler Martin Eichler Ulrich Kneser The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany—Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa) Cancers sarcoma defect reconstruction microsurgery reconstructive surgery plastic surgery |
| title | The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany—Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa) |
| title_full | The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany—Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa) |
| title_fullStr | The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany—Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa) |
| title_full_unstemmed | The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany—Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa) |
| title_short | The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany—Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa) |
| title_sort | therapeutic role of plastic and reconstructive surgery in the interdisciplinary treatment of soft tissue sarcomas in germany cross sectional results of a prospective nationwide observational study prosa |
| topic | sarcoma defect reconstruction microsurgery reconstructive surgery plastic surgery |
| url | https://www.mdpi.com/2072-6694/14/17/4312 |
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