Defining a textbook surgical outcome for patients undergoing surgical resection of intermediate and high‐grade soft tissue sarcomas of the extremities. Issue 5 (21st July 2020)

• Record Type: Journal Article
• Authors: Lazarides, Alexander L.; Cerullo, Marcelo; Moris, Dimitrios; Brigman, Brian E.; Blazer, Dan G.; Eward, William C.
• Is Part Of: Journal of surgical oncology. Volume 122:Issue 5(2020)
• Page Start: 884
• Page End: 896
• Publication Date: 2020-07-21
• Subjects: hospital volume -- National Cancer Database -- soft tissue sarcoma -- soft tissue sarcoma of the extremities -- textbook outcome; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.26087
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background: Quality measures for the surgical management soft tissue sarcoma of the extremity are limited. The purpose of this study was to define a textbook surgical outcome (TO) for soft tissue sarcoma of the extremities (STS‐E) and to examine its associations with hospital volume and overall survival. Methods: All patients in the National Cancer Database undergoing resection of primary STS‐E between 2004 and 2015 were identified. The primary outcome was a TO, defined as: hospital length of stay (LOS) <75th percentile, survival >90 days from the date of surgery, no readmission within 30 days of discharge, and negative surgical margins (R0 resection). Results: Overall, 7658 patients met criteria for inclusion; a TO was achieved in 4291 (56%) patients. Of patients who did not achieve TOs, 51.9% (n = 1748) had an extended LOS, and 47.3% (n = 1591) did not have negative margins. Older age, more medical comorbidities, and non‐white or black race were independently associated with not receiving a TO ( P = .034). With respect to tumor and treatment characteristics, larger tumor size, lower extremity location and higher grade were independently associated with not receiving a TO ( P < .001). Hospital volume was not associated with a TO. TOs conferred a significant survival benefit (hazrds ratio = 0.71 [0.65‐0.78], P < .001). A TO was associated with a 27.5% longer survival time ( P < .001). Conclusions: This study defined a TO in intermediate and high‐grade STS‐E and demonstrated that this outcome measure is associated with overall survival. Facility volume was not associated with a TO.