Endoscopic versus open surgery for soft tissue vascular anomalies and benign tumors: a two-center propensity score-matched study.

BACKGROUND

No large-scale study has compared the outcomes of soft-tissue endoscopic surgery (SOFTES) with conventional open surgery (OS) for vascular anomalies and benign soft tissue tumors. We aimed to compare the operative safety, efficacy, and outcomes of the two approaches for soft tissue lesions.

METHODS

Patients (n = 414) undergoing SOFTES or OS in two centers were retrospectively reviewed. Propensity score matching was used to minimize selection bias and group differences. The treatment outcomes were compared between the two groups.

RESULTS

After matching, 150 patients (SOFTES: 75; OS: 75) were included. Compared with the OS group, the estimated blood loss in the SOFTES group was significantly lower [20 mL (1-500) vs. 50 mL (5-600); p = 0.001]; however, the operative duration was significantly longer [223 minutes (35-490) vs. 173 minutes (37-494); p = 0.008]. Major complications were not observed. The incidence of focal burn of skin in the SOFTES group was higher than that in the OS group (p = 0.048). The incidences of superficial peroneal nerve injury, postoperative bleeding, persistent lymph drainage, local sensory paralyses (<5 cm2), surgical site infection, hematoma/seroma, and residual mild pain were not significantly different between the two groups. However, the incidence of wound dehiscence [n = 0 (0.00%) vs. n = 7 (9.33%); p = 0.010] and flap necrosis [n = 1 (1.33%) vs. n = 11 (14.67%); p = 0.005] was significantly higher in the OS group than in the SOFTES group. Residual pain was cured or significantly improved. All patients achieved resolution of contracture had normal or near-normal joint motion.

CONCLUSIONS

Endoscopic surgery is a safe and effective treatment option for various vascular anomalies and benign soft tissue tumors in selected patients. This paradigm shift has many advantages in terms of clinical outcomes and reduces postoperative complications.