Predictors of early soft tissue complications following upper extremity soft tissue sarcoma surgery: a contemporary single-center cohort

Soft tissue sarcomas (STS) are associated with substantial risk of postoperative soft tissue complications. Tumors in the upper extremity present unique functional and anatomical challenges, yet understanding of specific risk factors in this subgroup remains limited. This study determines predictors of soft tissue complications following surgical resection of upper extremity STS at a high-volume sarcoma center. We retrospectively analyzed 164 patients surgically treated for primary upper extremity STS from 2012 to 2022. Patient demographics, comorbidities, tumor characteristics, and treatment modalities, including neoadjuvant radiotherapy and chemotherapy, were evaluated. Soft tissue complications within 60 days postoperatively were recorded. Univariate and multivariate logistic regression analyses were performed to identify significant predictors. Fourteen patients (8.5%) developed soft tissue complications. On univariate analysis, insulin-dependent diabetes, lower preoperative hematocrit, larger tumor size, skin grafting, neoadjuvant radiotherapy, and longer operative time were significant predictors. On multivariate analysis, only skin grafting and neoadjuvant radiotherapy remained significant; hypofractionated radiotherapy yielded no increased risk compared to traditional radiotherapy. In this single-center, contemporary upper-extremity STS cohort, skin grafting and neoadjuvant radiotherapy were independent predictors for 60-day soft tissue complications; other risk factors included insulin-dependent diabetes, lower hematocrit, larger tumor size, and longer operative time. These findings may assist in perioperative risk stratification and counseling. Synopsis: Soft tissue complications remain a significant concern following upper extremity soft tissue sarcoma resection. This study evaluates risk factors contributing to these complications at a high-volume sarcoma center over a ten-year period. The findings highlight several risk factors for soft tissue complications, providing a foundation for improved risk stratification and careful treatment planning.