The Added Value of Plastic Surgery in the Multidisciplinary Management of Sarcoma Resection: A Multivariable Analysis of Predictors and Postoperative Outcomes.

BACKGROUND

Sarcomas are rare and heterogeneous malignancies arising from mesenchymal tissue, often requiring wide surgical resection that may result in large and complex soft and bony tissue defects needing complex reconstruction. Growing evidence indicates the added value of plastic surgery participation in multidisciplinary sarcoma care, yet evidence remains limited.

METHODS

This retrospective single-center study included patients who underwent resection for soft-tissue or bone sarcoma at Ghent University Hospital between 2010 and 2022. The patients were categorized according to closure strategy during the index procedure (oncologic-only closure vs combined oncologic-plastic closure). Three multivariable logistic regression models were fitted. One model identified preoperative predictors of combined oncologic-plastic surgery, and two models assessed postoperative outcomes (seroma formation and R0 margin status by closure strategy).

RESULTS

Of the 530 patients included, 409 (77.2 %) underwent primary tumor resection by the oncologic surgeon only, whereas 121 (22.8 %) had primary surgery performed by a combined oncologic-plastic team. Closure by the oncologic surgeon was independently predicted by upper leg location, whereas the combined oncologic-plastic operation was associated with myxofibrosarcoma histology, trunk location, high-grade tumors, and location superficial to the fascia. The combined oncologic-plastic approach reduced the formation of seroma. The R0 resection rates did not differ significantly between groups.

CONCLUSION

This study may help define clearer indications for early reconstructive input during sarcoma surgery. Early integration of plastic surgery within a multidisciplinary sarcoma team enables more comprehensive surgical planning and may both facilitate radical resections and improve postoperative wound outcomes.