Temporizing Wound VAC Dressing Until Final Negative Margins are Achieved Reduces Myxofibrosarcoma Local Recurrence

• Published in: Annals of surgical oncology 2021-12, Vol.28 (13), p.9171-9176
• Main Authors: Fourman, Mitchell S., Ramsey, Duncan C., Kleiner, Justin, Daud, Anser, Newman, Erik T., Schwab, Joseph H., Chen, Yen-Lin, DeLaney, Thomas F., Mullen, John T., Raskin, Kevin A., Lozano-Calderón, Santiago A.
• Format: Article
• Language: English
• Subjects: Adult; Bandages; Cancer therapies; Comorbidity; Fibrosarcoma - surgery; Hospitals; Humans; Margins of Excision; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - surgery; Oncology; Orthopedics; Patients; Radiation; Retrospective Studies; Sarcoma; Surgery; Surgical Oncology; Surgical outcomes; Tumors; Wounds
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-021-10242-4

Background The microinvasive nature of suprafascial myxofibrosarcoma reduces the accuracy of intraoperative margin assessment, and tumor bed resections after soft-tissue reconstruction are unreliable. In 2017, we began temporizing the excised tumor bed with a wound VAC, delaying soft-tissue coverage until final negative margins were achieved. We compare the oncologic/surgical outcomes of suprafascial myxofibrosarcomas managed with VAC temporization (VT) with single-stage excision/reconstruction (SS). Methods We retrospectively studied suprafascial myxofibrosarcomas managed from January 1, 2000 to January 1, 2019 for patients who received neoadjuvant or adjuvant radiation and had at least 2 years of oncologic follow-up at a tertiary referral cancer center. Our primary outcome was local recurrence. Comparisons were performed by using Fisher’s exact test or Student’s t test. A p value < 0.05 was considered significant. Results Fifty-three patients (18 VAC temporized, 35 single stage) were included. While VT patients were older (74.9 ± 10.2 vs. 63.9 ± 13.6, p = 0.003), treatment groups did not significantly differ with respect to comorbidity, tumor volume, stage and grade. VT patients had significantly fewer local recurrences (5.6% vs. 28.6% after SS, p = 0.048) and R1 resections that required an unplanned readmission for tumor bed reexcision (0% vs. 37.1% after SS, p = 0.002). VT required more total surgeries (2.8 ± 0.9 vs. 1.8 ± 0.9 for SS, p = 0.0002). Postoperative infectious and wound complications were equivalent. Conclusions Our VAC temporization strategy had a significantly lower LR than SS treatment. While high quality multi-institutional validation is required, VT may represent a paradigm shift in the management of myxofibrosarcoma.