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Neoadjuvant Chemotherapy and Endoprosthetic Reconstruction for Lower Extremity Sarcomas: Does Timing Impact Complication Rates?

  • Sarcoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Sarcoma patients undergoing surgical resection and endoprosthetic reconstruction often receive neoadjuvant chemotherapy (NACT). The objective of the current study was to determine if the timing of NACT impacts the rates of surgical site infections (SSI) and reoperations.

Methods

This study was a secondary analysis of the recently published Prophylactic Antibiotic Regimens in Tumor Surgery trial. Patients who underwent NACT, tumor resection, and endoprosthetic reconstruction for a bone or soft tissue sarcoma were included. Multivariate Cox proportional hazards regression models were created to evaluate if NACT timing was predictive of SSI or reoperations.

Results

Overall, 216 patients from 39 clinical sites were included in the analysis. The most common diagnosis was osteosarcoma (75%), followed by Ewing’s sarcoma (16%). The median time from completion of NACT to surgery was 24 days (interquartile range 15–42 days). Eighty-five (39%) patients underwent surgery within 3 weeks of completing NACT, 78 (36%) underwent surgery 3–6 weeks after completing NACT, and 53 (22%) patients underwent surgery > 6 weeks after completion of NACT. The timing of NACT did not impact SSI rates or reoperation rates. Longer operative time was an independent predictor of both SSI [hazard ratio (HR) per hour of 1.21, 95% confidence interval (CI) 1.07–1.40; p = 0.002] and reoperation rates (HR of 1.15 per hour, 95% CI 1.03–1.28; p = 0.014).

Conclusion

The timing of surgery following NACT varied considerably. Chemotherapy timing did not impact SSI or reoperations in patients undergoing surgical resection and endoprosthetic reconstruction in sarcoma patients.

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Funding

The PARITY Trial received funding through research grants from the Canadian Institutes of Health Research (CIHR), the Canadian Cancer Society Research Institute, the Canadian Orthopaedic Foundation, the Orthopaedic Research and Education Foundation in conjunction with the Musculoskeletal Tumor Society, and the Physicians’ Services Incorporated Research Grant.

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Authors and Affiliations

  1. Division of Orthopaedics, Department of Surgery, St. Joseph’s Hospital, McMaster University, Hamilton, ON, Canada

    Aaron M. Gazendam MD, MSc, Patricia Schneider BSc & Michelle Ghert MD, FRCSC

  2. Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA

    Andre Spiguel MD, FAAOS

Authors
  1. Aaron M. Gazendam MD, MSc
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  2. Patricia Schneider BSc
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  3. Andre Spiguel MD, FAAOS
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  4. Michelle Ghert MD, FRCSC
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Corresponding author

Correspondence to Aaron M. Gazendam MD, MSc.

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Disclosure

Michelle Ghert reports speaker fees from Stryker. Aaron M. Gazendam, Patricia Schneider, and Andre Spiguel declare no conflicts of interest.

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Investigation performed at McMaster University, Hamilton, ON, Canada on behalf of the PARITY Investigators.

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Gazendam, A.M., Schneider, P., Spiguel, A. et al. Neoadjuvant Chemotherapy and Endoprosthetic Reconstruction for Lower Extremity Sarcomas: Does Timing Impact Complication Rates?. Ann Surg Oncol 29, 7312–7317 (2022). https://doi.org/10.1245/s10434-022-12258-w

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  • DOI: https://doi.org/10.1245/s10434-022-12258-w

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