Effect of Negative Pressure Wound Therapy After Surgical Removal of Deep-Seated High-Malignant Soft Tissue Sarcomas of the Extremities and Trunk Wall. A Randomized Controlled Trial

Introduction

Sarcomas are a heterogeneous group of rare malignant tumors of mesenchymal cell origin in the musculoskeletal system comprising 1% of all adult cancers. The reported incidence of all types of sarcomas is approximately six to eight per 100,000 inhabitants corresponding to 300 cases per year in Denmark (250 STS (100 retroperitoneal/abdominal STS), 50 bone sarcomas). Sarcomas arise in the body's connective tissues including bone, muscle, cartilage, fat tissue, blood vessels, and peripheral nerve-sheaths and hence arise in all parts of the body although most dominant in the extremities (78%).

There exist more than 50 histologic subtypes of STS yielding a broad heterogeneous morphology and biological behavior of all subtypes. The incidence of STS is in general increasing with age (median age=65). High-grade soft tissue sarcomas mostly metastasize hematogenous to the lungs, which is also the primary cause of sarcoma-specific death and approximately 10% of patients with STS have metastases at diagnosis.

Treatment of STS requires a multidisciplinary highly specialized team, evaluating risks and benefits of all available options and expected outcomes with the aim to minimize the recurrence of disease and preserve function and quality of life. The main treatment principles that have largely been unchanged since the 1980ies is surgery supplemented with adjuvant radiotherapy depending on subtype and stage. The use of NPWT after high-risk orthopedic surgeries such as e.g. amputations, treatment of open fractures and joint replacement surgery are increasing, but the direct cost is much higher compared to the conventional wound dressing. However, previous studies have shown that NPWT can reduce postoperative complications such as wound dehiscence and infection. STS surgery that is often combined with pre-or postoperative radiation therapy is a high-risk procedure concerning wound complications and postoperative infections. A retrospective study showed that NPWT reduced the risk of wound complications in patients with lower extremity STS treated with preoperative radiation and the use of NPWT was not associated with an increased risk of local recurrence.

Methods