Our findings may have significant implications for the quality of care provided to patients who undergo surgery to resect sarcomas in the deep soft tissue of the limbs.
—Robert J. Canter, MD, MAS
Nearly half the surgical procedures for sarcoma done at 85 academic medical centers were performed by surgeons untrained in oncology, according to national data analyzed by researchers from the University of California Davis Medical Center, Sacramento.
Orthopedic oncologists and surgical oncologists, who have been trained in the complex procedures required to remove sarcomas located deep in the muscles and soft tissues of the limbs, conducted only 52% of these operations during a 3-year period, according to the study published in the Journal of Surgical Oncology.1
The remaining 48% of these extremity soft tissue tumor resections were conducted by general surgeons, plastic surgeons, and orthopedic surgeons, whose fellowship training does not emphasize the multidisciplinary evaluation and surgical management of these challenging lesions, said lead author of the study Robert J. Canter, MD, MAS, Associate Professor of Surgery at University of California Davis.
The study is the first to examine the overall frequency and distribution nationwide of the different surgical specialists who remove sarcomas and similar tumors.
The researchers queried the University Health System Consortium and the Association of American Medical Colleges database on 85 institutions for the years 2007 to 2009. They identified 2,195 general surgeons, 792 plastic surgeons, 533 surgical oncologists, 1,079 general orthopedic surgeons, and 83 orthopedic oncologists.
Non–oncology-trained surgeons performed approximately 50% of deep and malignant soft tissue tumor resections. Adjusting for the number of physicians in the database, the investigators determined that of the total deep and malignant extremity soft tissue tumor resections, 9.4% were performed by general surgeons, 7.7% by plastic surgeons, 26.0% by surgical oncologists, 30.8% by general orthopedic surgeons, and 26.0% by orthopedic oncologists.
In contrast, the mean number of operations to remove nonmalignant subcutaneous soft tissue tumors did not differ significantly among the specialists.
The analysis also revealed that 17% of the cancer operations were by surgeons who performed an average of only one or two of these procedures each year. Previous studies have linked better clinical outcomes with higher volume. The database does not include information about clinical outcomes.
Implications for Quality of Care
“Our findings may have significant implications for the quality of care provided to patients who undergo surgery to resect sarcomas in the deep soft tissue of the limbs,” Dr. Canter said.
He suggested that orthopedic or surgical oncologists are probably more likely to achieve negative surgical margins, thus helping patients to avoid additional surgeries and death from recurrence. About 50% of soft tissue sarcomas occur in the limbs, and about 50% metastasize. Part of the problem is that, since sarcomas are rare, some tumors may remain undiagnosed at the time of surgery and the need for an oncologist may not be recognized.
The National Comprehensive Cancer Network and the European Society of Medical Oncology recommend that only surgeons with expertise and training in the management of soft tissue sarcomas should operate on patients with tumors that may be sarcomas. ■
Disclosure: The study was funded by the Department of Surgery at the University of California Davis Health System.
1. Canter RJ, Smith CA, Martinez SR: Extremity soft tissue tumor surgery by surgical specialty: A comparison of case volume among oncology and non-oncology-designated surgeons. J Surg Oncol. July 3, 2013 (early release online).