Title

Unplanned resection of sarcoma

Document Type

Journal Article

Publication Date

1-1-2016

Journal

Journal of the American Academy of Orthopaedic Surgeons

Volume

24

Issue

3

DOI

10.5435/JAAOS-D-15-00074

Abstract

Copyright © 2016 the American Academy of Orthopaedic Surgeons. Unplanned resection is a common problem in the management of sarcoma. Because sarcomas are so rare, they may be misdiagnosed initially as more common benign lesions. When the treating surgeon is unaware of or does not adhere to proper surgical principles of orthopaedic oncology, an intralesional procedure may be performed without the requisite preoperative imaging, staging, or wide resection margins for optimal management of sarcoma. Studies show that oncologic outcomes after unplanned resections are mixed; however, surgical outcomes drastically deteriorate. Failure to adhere to oncologic principles accounts for increased morbidity and amputation rates with re-resection. No diagnostic modality has been proven to accurately predict residual disease in the resection bed following unplanned resection. Thus, repeat surgery with or without adjuvant treatment is usually offered to these patients, thereby adding considerable cost and morbidity. Medical malpractice litigation associated with unplanned sarcoma resectioniscommon, with delayed diagnosis and unnecessary amputation most often cited in cases decided in favor of the plaintiff.

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