Is delayed three-month re-excision safe for patients who have undergone unplanned excision of soft tissue sarcomas?

BACKGROUND: The optimal timing for systematic re-excision following the unplanned excision (UE) of soft tissue sarcomas (STS) remains controversial. This study evaluated the impact of delayed versus immediate re-excision on overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS). METHODS: We retrospectively analysed patients who underwent re-excision for primary STS following UE between August 2011 and February 2019. Patients with metastasis at presentation or a follow-up of less than two years were excluded. The cohort was stratified into an early re-excision (RE) group (≤ 3 months from initial UE) and a late RE group (> 3 months). The LRFS, PFS, OS, and the extent of excision were assessed. RESULTS: A total of 104 patients met the inclusion criteria of this study, including 74 cases in the early RE group and 30 cases in the late RE group. At a mean follow-up of 61.0 ± 20.5 months, the 5-year OS was 86.5% and 88.1% in the early RE group and the late RE group, respectively (P=0.501). No significant differences were observed in 5-year LRFS (98.9% vs. 88.8%, P=0.168) or 5-year MRFS (88.6% vs. 81.9%, P=0.764). For a subset of 12 patients in the late RE group who underwent serial MRI, the median maximum edema diameter decreased significantly from 93.8 mm at the initial visit to 54.9 mm prior to delayed re-excision (P=0.001) CONCLUSIONS: Delayed re-excision beyond three months did not negatively impact recurrence or survival rates compared to immediate intervention. Furthermore, this delayed approach allows postoperative edema to subside, potentially reducing the required extent of resection and the subsequent need for complex flap reconstruction.