Surgery at specialised sarcoma centres improves patient outcomes - A systematic review by the Australia and New Zealand sarcoma association clinical practice guidelines working party

Angela M Hong; Abay Sundaram; Ganaps Perianayagam; Helen Lo; Anna Lawless; Deborah Zhou; Joshua McDonough; Stephen R Thompson; Fiona Maclean; Elizabeth A Connolly; David Coker; Jasmine Mar; Smaro Lazarakis; Andrew Johnston

doi:10.1016/j.ejso.2023.06.003

Surgery at specialised sarcoma centres improves patient outcomes - A systematic review by the Australia and New Zealand sarcoma association clinical practice guidelines working party

Eur J Surg Oncol. 2023 Sep;49(9):106951. doi: 10.1016/j.ejso.2023.06.003. Epub 2023 Jun 7.

Authors

Affiliations

¹ Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia. Electronic address: [email protected].
² Department of Orthopaedic Surgery, Sir Charles Gardiner Hospital, Nedlands, WA, 6009, Australia.
³ Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.
⁴ Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia; Mid North Coast Cancer Institute, Port Macquarie, NSW, 2444, Australia.
⁵ Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia.
⁶ NHMRC Clinical Trials Centre, The University of Sydney, NSW, 2006, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia.
⁷ The University of Adelaide, Adelaide, SA, 5005, Australia.
⁸ Faculty of Medicine, University of New South Wales, Randwick, NSW, 2131, Australia; Department of Radiation Oncology, Prince of Wales Hospital, Randwick, NSW, 2132, Australia.
⁹ Douglass Hanly Moir Pathology, North Ryde, NSW, 2113, Australia.
¹⁰ Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia.
¹¹ Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia; Department of Melanoma and Surgical Oncology, and Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.
¹² Australia and New Zealand Sarcoma Association, Parkville, Victoria, 3010, Australia.
¹³ Health Sciences Library, Royal Melbourne Hospital, Parkville, Victoria, 3010, Australia.
¹⁴ Auckland District Health Board, Auckland, 1023, New Zealand.

PMID: 37301636
DOI: 10.1016/j.ejso.2023.06.003

Abstract

Background: Optimal management of sarcoma requires multidisciplinary team input throughout the process of diagnosis, treatment and follow up. This systematic review aimed to evaluate the impact of surgery performed at specialised sarcoma centres on outcomes.

Methods: A systematic review was conducted using the population, intervention, comparison and outcome (PICO) model. Medline, Embase, Cochrane Central databases were queried for publications that evaluated the local control, limb salvage rate, 30-day and 90-day surgical mortality, and overall survival in patients undergoing surgery in a specialist sarcoma centre compared with non-specialist centre. Each study was screened by two independent reviewers for suitability. A qualitative synthesis of the results was performed.

Results: Sixty-six studies were identified. The majority of studies were Level III-3 as assessed by the NHMRC Evidence Hierarchy, whilst just over half of the studies were of good quality. Definitive surgery performed at specialised sarcoma centres was associated with improved local control as defined by lower rate of local relapse, higher rate of negative surgical margins, improved local recurrence free survival and higher limb conservation rate. Available evidences show a favourable pattern of lower 30-day and 90-day mortality rates, and greater overall survival when surgery was performed in specialist sarcoma centres compared with non-specialised centres.

Conclusions: Evidences support better oncological outcomes when surgery is performed at specialised sarcoma centre. Patients with suspected sarcoma should be referred early to a specialised sarcoma centre for multidisciplinary management, which includes planned biopsy and definitive surgery.

Keywords: Bone sarcoma; Limb salvage; Sarcoma; Soft tissue sarcoma; Specialised centre; Surgery.

Publication types

Systematic Review
Review

MeSH terms

Australia
Humans
Neoplasm Recurrence, Local / epidemiology
New Zealand
Retrospective Studies
Sarcoma* / diagnosis
Sarcoma* / surgery
Soft Tissue Neoplasms* / surgery