Inadvertent excision of malignant soft tissue tumours

[摘要] Soft tissue sarcomas (STS) are rare, with a combined incidence of about 60/100,000 population a year. It is generally stated that there are 100 benign soft tissue tumours for every soft tissue sarcoma. As a result of this there is a low level of awareness of the possibility of a sarcoma entering the differential diagnosis in many situations. Delays in diagnosis of both bone and soft tissue sarcomas are common, and paralleling this is the high frequency of inadvertent excision (IE) of lesions which then turn out to be sarcomas. This was first described by Giuliano and Eilber in 19851 but has undoubtedly been commonplace for many years. It has acquired the eponym of a ‘whoops’ procedure as the surgeon (and the patient) are both surprised and maybe distressed when the pathologist reports that the lesion which they thought was benign, is in fact malignant!2 Almost always the surgeon will have ‘shelled out’ the lump and will usually confidently say that they ‘have got it all out’. In the past many of these patients then had no further treatment but there was a very high rate of local recurrence (up to 70%) and it is now far more common for these patients to be referred to a sarcoma unit for definitive management.2 In 1994, Gustafson et al showed that patients treated somewhere other than a tumour centre required significantly more operations than those treated primarily at a tumour centre, either to have a reexcision to get clear margins, or for management of local recurrence.

[学科分类] 神经科学

[关键词] inadvertent excision;local recurrence;soft tissue sarcoma;unplanned excision;wide re-excision