Analysis of risk factors and impact of tumor size in radical soft tissue sarcoma resection

Introduction: There is relatively little current literature analyzing predictive factors of postoperative complications in radical soft tissue sarcoma (STS) resection. The goal was to analyze risk factors based on STS size (< 5 cm vs. > 5 cm) with regard to STS resection in a large up-to-date, multicenter, population-based study. Additionally, we sought to determine any independent risk factors for the development of postoperative complications. Methods: Our study was completed through a retrospective analysis of 2005-2014 American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP). Data were queried for patients undergoing radical resection for soft tissue tumor based on CPT code. Univariate analysis, t-test, and multivariate logistic regressions were employed adjusting for patient demographic, preoperative, and intraoperative variables in order to identify patient- and surgery-specific predictive factors for patients who developed complications. Results: Based on the 1,845 patients who met the inclusion criteria, 1,709 (92.62%) had a STS smaller than 5 cm and 136 (7.37%) had tumors larger than 5 cm. Results indicate that larger tumors yield greater risk and greater potential for wound complications. Specifically, adult patients who had radical resection of soft tissue tumors greater than 5 cm were more likely to have inpatient status, history of smoking, hypertension, disseminated cancer, chemotherapy and radiation, and were more likely to have longer length of stay in the hospital. Conclusion: The results indicate that larger tumors (> 5 cm) carry greater risk for complications. We hypothesize that this may be due to larger tumors being more invasive and requiring greater surgical manipulation. As such, it is important to provide appropriate counseling and proper preoperative planning for these patients.