Many Sarcoma Surgeries Performed by Non-Oncologic Surgeons

Almost half of the resections performed for deep and malignant extremity soft-tissue sarcomas are done by non-oncology surgeons including orthopedic surgeons and general surgeons, according to a new study. A substantial number of these procedures are done by surgeons who perform only one or two each year.

“Our findings may have significant implications for the quality of care provided to patients who undergo to resect, or remove, sarcomas in the deep soft tissue of the limbs,” said study lead author Robert J. Canter, MD, of the University of California, Davis, in a press release. The new study was published online ahead of print on July 3 in the Journal of Surgical Oncology. About half of all soft-tissue sarcomas occur in the extremities.

The investigators used a database maintained by the University Health System Consortium and the Association of American Medical Colleges to analyze procedures performed at 85 centers between 2007 and 2009.

The analysis included a total of 4,682 practitioners, divided among general surgeons (n = 2,195), plastic surgeons (n = 792), oncologic surgeons (n = 533), general orthopedic surgeons (n = 1,079), and orthopedic oncologic surgeons (n = 83). After adjusting for the number of physicians in the database, the researchers found that for all deep and malignant extremity soft-tissue tumor resections 26% were performed by oncologic surgeons and 26% by orthopedic oncologic surgeons. The rest-47.9% of the total-were performed by the other specialties who are not specifically trained in resecting deep soft-tissue sarcomas.

Specifically, general surgeons performed 9.4% of the total, plastic surgeons performed 7.7% of the resections, and general orthopedic surgeons performed the remaining 30.8%. The analysis also showed that 17% of all such procedures are performed by surgeons who only average one or two per year.

The investigators also looked into which specialties were more likely to perform specific types of procedures beyond just the deep and malignant soft-tissue tumor resection. Musculoskeletal procedures were more likely to be performed by general orthopedic surgeons (798.6 procedures per year) and orthopedic oncologic surgeons (482.9 per year) than by general surgeons (19 per year) and oncologic surgeons (32.4 per year), with plastic surgeons in the middle (179.6 per year). Subcutaneous procedures were similar across all specialties, while deep and malignant resections were more likely performed by orthopedic oncologic surgeons.

In an accompanying editorial, R. Lor Randall, MD, of Huntsman Cancer Institute at the University of Utah in Salt Lake City, wrote that while suggestive, the study was limited by a lack of confirmatory pathology for the tumors that were resected, as well as a lack of outcome data. “As sarcoma surgeons, we feel strongly that we should be the ones caring for these patients,” he wrote. “However, on behalf of our sarcoma patients worldwide, the onus remains on surgical oncologists to demonstrate that our results are superior because of our training and multidisciplinary programs.”