Partial and inadvertent excisions of soft tissue sarcomas: a prospective analysis of referrals to the Oxford Sarcoma Service

Aims Delays to diagnosis and management of soft tissue sarcomas are preventable but still occur. The introduction of a referral proforma to the Thames Valley Cancer Network in 2005 and National guidelines in 2006 aimed to decrease the incidence of partially and inadequately managed soft tissue sarcomas. This study aims to assess referrals for partially or inadequately managed soft tissue sarcomas and their subsequent management. Methods A prospective analysis of all patients referred to the Oxford Sarcoma Service following inadvertent excision of a soft tissue sarcoma between January 2010 and August 2011 was carried out. Pre-operative investigation and subsequent secondary managements were recorded. Patients with a diagnosis of dermatofibrosarcoma protuberans were excluded. Results 24 patients (17 male) with a mean age of 54.3 (6–96), representing 14.5% of all soft tissue sarcomas during this time period were followed up following incomplete or inadvertent excision. 66% were referred from secondary care, 54% had no pre-operative imaging, with the remainder having incomplete imaging. 79% of lesions were found in the extremities, with 12.5 % presenting with metastatic disease. 79% required further surgery, with 8% requiring amputation. The most common pathologies were leiomyosarcoma (29.1%), fibromyxoid sarcoma (12.5%), spindle cell sarcoma (12.5 %) and liposarcoma (8.3%). Conclusion The consequences of incomplete initial management of soft tissue sarcomas are a cause of significant morbidity and demand on health care services. The introduction of referral guidelines has not prevented the partial management of these lesions.