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dc.contributor.authorSivarajah, G
dc.contributor.authorDavies, E
dc.contributor.authorHurley, A
dc.contributor.authorStrauss, DC
dc.contributor.authorSmith, MJF
dc.contributor.authorHayes, AJ
dc.date.accessioned2022-04-27T12:15:35Z
dc.date.available2022-04-27T12:15:35Z
dc.date.issued2022-02-03
dc.identifier.citationAnnals of surgical oncology, 2022en
dc.identifier.issn1068-9265
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/5101
dc.identifier.eissn1534-4681en_US
dc.identifier.eissn1534-4681
dc.identifier.doi10.1245/s10434-021-11292-4en_US
dc.identifier.doi10.1245/s10434-021-11292-4
dc.description.abstract<h4>Background</h4>While surgery remains the mainstay of treatment for limb sarcoma, extreme old age is a relative contraindication to oncological surgery.<h4>Methods</h4>Patients >80 years referred with primary extremity soft-tissue sarcoma (ESTS) between 2007 and 2016 were retrospectively reviewed. Prognostic variables, including ASA status and Clinical Frailty Scores, were collected. Endpoints were perioperative morbidity, locoregional (LRR) and distant recurrence (DR), disease-specific survival (DSS) adjusted using competing risk modelling, and overall survival (OS).<h4>Results</h4>A total of 141 primary tumours were identified, with 116 undergoing resections. Main motives for nonoperative management were severe frailty or significant comorbidity (56.0%). The operative group had a median age of 84 (range 80-96) years and median follow-up of 16 months (range 0-95). 45.7% of patients received radiotherapy. Median hospital stay was 7 (range 0-40) days, with frailty (p = 0.25) and ASA (p = 0.28) not associated with prolonged admission. 12.9% developed significant complications, with one perioperative mortality. 24.1% had LRR, occurring at a median of 14.5 months. All patients with reported DR (28.4%), except one, died of their disease. Frailty did not confer a significant difference in adjusted LRFS (p = 0.95) and DMFS (p = 0.84). One- and 5-year adjusted DSS and OS was 87.0% versus 74.9% and 62.3% versus 27.4%, respectively. Frailty (CFS ≥4) was associated with worse OS (hazard ratio [HR] 2.49; 95% confidence interval [CI] 1.51-4.12; p < 0.001), however not with adjusted DSS (p = 0.16). Nonoperative management conferred a 1- and 5-year adjusted DSS was 58.3% and 44.4%, respectively.<h4>Conclusions</h4>Extremity surgery for sarcoma is well tolerated in the frail very elderly population with low morbidity and comparable oncological outcomes.en_US
dc.formatPrint-Electronicen_US
dc.languageengen_US
dc.language.isoengen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.titleFrailty in Very Elderly Patients is Not Associated with Adverse Surgical or Oncological Outcomes in Extremity Surgery for Soft Tissue Sarcoma.en
dc.typeJournal Article
dcterms.dateAccepted2021-12-15
rioxxterms.versionVoRen
rioxxterms.versionofrecord10.1245/s10434-021-11292-4en
rioxxterms.licenseref.startdate2022-02-03
dc.relation.isPartOfAnnals of surgical oncologyen_US
pubs.notesNot knownen_US
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/ICR Divisions
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging/Sarcoma and Melanoma Surgery
pubs.publication-statusPublisheden_US
pubs.embargo.termsNot knownen_US
icr.researchteamSarcoma and Melanoma Surgery
dc.contributor.icrauthorHayes, Andrewen_US
dc.contributor.icrauthorSmith, Mylesen_US


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