Einflussfaktoren auf die Wundheilung nach operativer Therapie von Weichteilsarkomen

Abstract

Abstract— Background and Objectives: Due to multimodality treatment and extended operations patients with soft tissue sarcomas are at high risk for impaired wound healing. The purpose of this study is to determine and reevaluate risk factors especially with regard to timing of radiotherapy. Methods: For this retrospective study we identified 234 STS patients who underwent resection between 1995-2011 and analyzed the influence of multiple patient, tumor and surgery characteristics on wound healing. We defined wound healing complications as wound healing problems identified and named in an orthopedic checking. We subdivided those into conservatively treated ones and complications that required revision surgery . Chi-Square test, Fisher`s exact test and Mann-Whitney-U-test were predominantly used in monovariate analyses. For multivariate analyses of the potential risk factors a bivariate logistic regression was performed. Results: Median tumor volume was 162cm³, 40% were initially graded as G3 and with 57% most frequently in Stage 1. Altogether 28% of the patients developed wound healing complications post STS resection. 11% were treated conservatively and 17% had to undergo revision. 60% of the patients received radiotherapy, 44% were irradiated postoperatively and 16% preoperatively. In univariate analyses higher initial stage and grade, neoadjuvant radiotherapy, larger tumor volumes, extended need of perioperative transfusions, longer duration of surgery and performance of reconstructive procedures were associated with an impaired wound healing. In the following logistic regression just the duration of surgery (OR=1,445, p=0,03) and the performance of reconstructive procedures (OR=2,213, p=0,027) stayed independent predictors for the occurrence of wound healing complications. Conclusion: There are multiple risk factors for an impaired wound healing post STS resection. In cases with multiple risk factors where a neoadjuvant radiotherapy is indicated, patients should be counseled specifically and therapy should be planned anticipatory with regard to treatment of potential wound heaing complications.