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Management and outcomes of ruptured, perforated or fistulized tumors of mesenchymal origin
Author(s) -
Asare Elliot A.,
Davis Catherine H.,
Chiang YiJu,
Sabir Sharjeel,
Rajkot Nikita F.,
Phillips Paula R.,
Roland Christina L.,
Torres Keilla E.,
Hunt Kelly K.,
Feig Barry W.
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25807
Subject(s) - medicine , sepsis , perioperative , surgery , percutaneous , sarcoma , parenteral nutrition , pathology
Background Patients with ruptured, perforated or fistulized (RPF) sarcomas commonly have issues such as sepsis and malnutrition and are usually unsuitable for oncologic resection in the emergency setting. We present our approach for managing a series of patients and the outcomes which were achieved with multidisciplinary care. Methods We reviewed records of patients referred to the section of sarcoma surgical oncology. Clinicopathologic factors, preoperative and operative interventions as well as short‐term oncologic outcomes were assessed. Results Sixteen patients were identified between 1 January 1998 to 31 December 2018. Median age was 42.8 years. Histologies were; Gastrointestinal stromal tumors (7), desmoid (4), spindle cell tumor (2), dedifferentiated liposarcoma (2), and nonseminomatous germ cell tumor (1). Five patients had preoperative sepsis, 8 received antimicrobials, and 50% required hospitalization with a median stay of 21 days. Total parenteral nutrition was administered to 5 (31.3%) patients. Median tumor size and estimated blood loss were 13.1 cm and 350 mL respectively. No perioperative mortality occurred. Two patients have expired at a median follow‐up of 16.1 months. Conclusion Preoperative optimization, including the use of percutaneous drains, and antibiotics to control sepsis, where necessary, can lead to eventual oncologic resection with acceptable morbidity and no short‐term mortality for patients with RPF sarcomas.