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Risk Factors for Wound Complications after Sarcoma Resection in the Lower Extremity
Vol. 225, No. 4S1, October 2017
not impact the findings, and further controlling for patient and hospital characteristics resulted in an adjusted OR of 1.18 (CI 1.10e1.26) and 1.29 (CI 1.25e1.44) for intermediate and long distance, respectively. Subgroup analysis for very thin melanoma (<0.75 mm) noted a 27% higher chance of undergoing SLNB if a long distance was traveled for care.
CONCLUSIONS: There is a stepwise increase in the likelihood of receiving an SLNB for thin melanoma with increasing distance traveled for care. Risk Factors for Wound Complications after Sarcoma Resection in the Lower Extremity David P Perrault, Gene K Lee, MD, Antoine Lyonel Carre, MD, MPH, Roy Yu, Anmol Chattha, Maxwell Johnsom, Joseph N Carey, MD, William W Tseng, MD, Lawrence R Menendez, MD, FACS, Alex K Wong, MD, FACS University of Southern California, Los Angeles, CA INTRODUCTION: Complications after closure of defects from limb-sparing sarcoma resection are common. Early intervention with reconstructive techniques, including coverage with vascularized tissue, may avoid wound-related morbidity. We aimed to investigate the factors associated with wound complications at our institution. METHODS: A retrospective chart review was performed for 118 patients who had undergone resection of bone or soft tissue sarcoma in the lower extremity from April 2009 to August 2016. Patient demographics, tumor metrics, and postoperative complications were abstracted. Student’s t-test was used for continuous data and Pearson’s chi-square test for categorical data. Statistical analyses were performed in SPSS version 24 (IBM Corp). RESULTS: Of 118 patients who underwent resection of a bone or soft tissue sarcoma, there were 56 reported complications. The most common were wound infection (22.9%, 27/118), seroma formation (19.5%, 23/118), nonhealing wound (9.3%, 11/118), dehiscence (8.5%, 10/118), tissue necrosis (5.1%, 6/ 118), and hematoma formation (3.4%, 4/118). Neoadjuvant chemotherapy was associated with a statistically significant increase in the proportion of wound complications. Likewise, those with tumors located at the knee also had a statistically significant
Scientific Forum Abstracts
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increase in the proportion of wound complications. Other patient demographics and comorbidities, other tumor locations, tumor volume, adjuvant chemotherapy, neoadjuvant radiation, and adjuvant radiation were not significantly associated with greater complication rates in this series. CONCLUSIONS: Neoadjuvant chemotherapy and tumor location at the knee were associated with an increased complication rate. In high risk patients identified by predictive factors of wound complications, early reconstruction with vascularized tissue may minimize postoperative morbidity.
Robotic Resection of Small Pulmonary Nodules after Image-Guided Marker Placement Konstantinos P Economopoulos, MD, Leonidas Tapias, MD, Brett Broussard, MD, Philipp T Moser, MD, Amita Sharma, MD, Joanne O Shepard, MD, Florian J Fintelmann, MD, Shaunagh McDermott, MD, Douglas J Mathisen, MD, Harald C Ott, MD Massachusetts General Hospital, Harvard Medical School, Boston, MA INTRODUCTION: An increasing number of patients require resection of small lung nodules for tissue diagnosis and treatment. Robot-assisted thoracoscopic resection offers a minimally invasive alternative, but does not allow for palpation to localize difficult to find nodules. We hypothesized that preoperative placement of fiducial markers may enable adequate nodule localization during robotic lung resection. METHODS: A retrospective review of all patients managed with preoperative localization of pulmonary nodules with fiducial markers and robotic lung resection from October 2015 to December 2016 in a tertiary care center was performed. Patient characteristics, nodule features, fiducial placement details, and postoperative outcomes were recorded. RESULTS: Twelve CT-guided percutaneous procedures were performed in 11 patients. Twenty-five fiducial markers were placed to localize 14 lung nodules planned to be excised using robot-assisted thoracoscopic surgery. The median age of patients was 64 years (range 54 to 77 years), 8 were women, and 9 were former or current smokers. Median nodule size was 9.5 mm (2 to 25 mm), and CT scan attenuation ranged from solid to ground glass. Nodules were located at a median distance of 13 mm (4 to 43 mm) from the nearest surgical margin. The majority of nodules were minimally invasive adenocarcinomas (n ¼ 5) followed by invasive adenocarcinomas (n ¼ 3), and adenocarcinomas in situ (n ¼ 3). Surgical margins were negative in all cases. There were no deaths at 30 days after surgery. Aside from prolonged air leak in 2 patients (16.7%), there were no surgical complications. Median length of hospital stay was 2 days (range 1 to 12 days). CONCLUSIONS: Preoperative fiducial marker placement is a safe and effective method of localization of small pulmonary nodules prior to robotic lung resections.
not impact the findings, and further controlling for patient and hospital characteristics resulted in an adjusted OR of 1.18 (CI 1.10e1.26) and 1.29 (CI 1.25e1.44) for intermediate and long distance, respectively. Subgroup analysis for very thin melanoma (<0.75 mm) noted a 27% higher chance of undergoing SLNB if a long distance was traveled for care.
CONCLUSIONS: There is a stepwise increase in the likelihood of receiving an SLNB for thin melanoma with increasing distance traveled for care. Risk Factors for Wound Complications after Sarcoma Resection in the Lower Extremity David P Perrault, Gene K Lee, MD, Antoine Lyonel Carre, MD, MPH, Roy Yu, Anmol Chattha, Maxwell Johnsom, Joseph N Carey, MD, William W Tseng, MD, Lawrence R Menendez, MD, FACS, Alex K Wong, MD, FACS University of Southern California, Los Angeles, CA INTRODUCTION: Complications after closure of defects from limb-sparing sarcoma resection are common. Early intervention with reconstructive techniques, including coverage with vascularized tissue, may avoid wound-related morbidity. We aimed to investigate the factors associated with wound complications at our institution. METHODS: A retrospective chart review was performed for 118 patients who had undergone resection of bone or soft tissue sarcoma in the lower extremity from April 2009 to August 2016. Patient demographics, tumor metrics, and postoperative complications were abstracted. Student’s t-test was used for continuous data and Pearson’s chi-square test for categorical data. Statistical analyses were performed in SPSS version 24 (IBM Corp). RESULTS: Of 118 patients who underwent resection of a bone or soft tissue sarcoma, there were 56 reported complications. The most common were wound infection (22.9%, 27/118), seroma formation (19.5%, 23/118), nonhealing wound (9.3%, 11/118), dehiscence (8.5%, 10/118), tissue necrosis (5.1%, 6/ 118), and hematoma formation (3.4%, 4/118). Neoadjuvant chemotherapy was associated with a statistically significant increase in the proportion of wound complications. Likewise, those with tumors located at the knee also had a statistically significant
Scientific Forum Abstracts
S197
increase in the proportion of wound complications. Other patient demographics and comorbidities, other tumor locations, tumor volume, adjuvant chemotherapy, neoadjuvant radiation, and adjuvant radiation were not significantly associated with greater complication rates in this series. CONCLUSIONS: Neoadjuvant chemotherapy and tumor location at the knee were associated with an increased complication rate. In high risk patients identified by predictive factors of wound complications, early reconstruction with vascularized tissue may minimize postoperative morbidity.
Robotic Resection of Small Pulmonary Nodules after Image-Guided Marker Placement Konstantinos P Economopoulos, MD, Leonidas Tapias, MD, Brett Broussard, MD, Philipp T Moser, MD, Amita Sharma, MD, Joanne O Shepard, MD, Florian J Fintelmann, MD, Shaunagh McDermott, MD, Douglas J Mathisen, MD, Harald C Ott, MD Massachusetts General Hospital, Harvard Medical School, Boston, MA INTRODUCTION: An increasing number of patients require resection of small lung nodules for tissue diagnosis and treatment. Robot-assisted thoracoscopic resection offers a minimally invasive alternative, but does not allow for palpation to localize difficult to find nodules. We hypothesized that preoperative placement of fiducial markers may enable adequate nodule localization during robotic lung resection. METHODS: A retrospective review of all patients managed with preoperative localization of pulmonary nodules with fiducial markers and robotic lung resection from October 2015 to December 2016 in a tertiary care center was performed. Patient characteristics, nodule features, fiducial placement details, and postoperative outcomes were recorded. RESULTS: Twelve CT-guided percutaneous procedures were performed in 11 patients. Twenty-five fiducial markers were placed to localize 14 lung nodules planned to be excised using robot-assisted thoracoscopic surgery. The median age of patients was 64 years (range 54 to 77 years), 8 were women, and 9 were former or current smokers. Median nodule size was 9.5 mm (2 to 25 mm), and CT scan attenuation ranged from solid to ground glass. Nodules were located at a median distance of 13 mm (4 to 43 mm) from the nearest surgical margin. The majority of nodules were minimally invasive adenocarcinomas (n ¼ 5) followed by invasive adenocarcinomas (n ¼ 3), and adenocarcinomas in situ (n ¼ 3). Surgical margins were negative in all cases. There were no deaths at 30 days after surgery. Aside from prolonged air leak in 2 patients (16.7%), there were no surgical complications. Median length of hospital stay was 2 days (range 1 to 12 days). CONCLUSIONS: Preoperative fiducial marker placement is a safe and effective method of localization of small pulmonary nodules prior to robotic lung resections.