A REVIEW OF PLASTIC SURGERY INVOLVEMENT IN GROIN SARCOMA EXCISION.

Abstract

Introduction: The Plastic Surgery challenge in groin sarcoma is often twofold involving restoration of integrity to the lower abdominal wall and provision of durable soft tissue cover for the groin and perineum.

Methods: This is a retrospective review of consecutive patients undergoing groin sarcoma excision with plastic surgery involvement over the last 7 years. The referral patterns of these patients, histological types, margins and details of reconstructions performed were analysed. Information was also gathered regarding adjuvant therapy, recurrences and survival.

Results: Thirteen patients were included in this review. In twelve out of the thirteen patients initial biopsies/explorations were performed by either General Surgeons or Urologists. Ten of these biopsies were incompletely excised. On average 4.4 months elapsed between initial biopsy and referral to the Regional Sarcoma Service.

The most frequently performed reconstruction was a rectus abdominis musculo-cutaneous flap. Six patients developed post operative complications.

Complete/adequate surgical margins were achieved in seven patients. A further five patients had margins designated as “narrow” or “marginal”.

Six patients received post operative radiotherapy based on the multidisciplinary clinic review. Three patients were referred for radiotherapy but did not receive treatment. Five patients developed recurrences and four of these patients died.

Discussion: Groin sarcomas represent a surgical and logistical challenge.

The anatomical topography makes complete surgical excision difficult without available reconstructive techniques and complication rates can be high.

Referral of these patients to the regional sarcoma service is often delayed whilst exploration or biopsy is performed. This delay can persist even after a diagnosis of sarcoma has been made. Communication with colleagues in other centres may be the key to improving this side of management.