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Original article
Impact of Unplanned Resection and Re-excision of a Soft Tissue Sarcoma on Prognosis
Impacto de la resección no planificada y la reintervención de sarcomas de partes blandas en su pronóstico
Paula Muñoz Muñoz
Corresponding author
paumozmoz@gmail.com

Corresponding author.
, Mariam Bajawi Carretero, Alberto González Barranquero, Antonio Mena Mateos, Sara Corral Moreno, Alfonso Sanjuanbenito Dehesa, Jacobo Cabañas Montero, Eduardo Lobo Martínez
Servicio de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Soft tissue sarcomas &#40;STS&#41; are a heterogeneous group of tumors with more than 70 different histological types&#44; and their prognosis is determined by the characteristics of the primary tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> They are rare lesions&#44; so it is common for them to be managed incorrectly&#44; compromising the prognosis of the disease&#46; These are aggressive tumors&#44; and it is estimated that approximately 50&#37; of patients will die from their sarcoma&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; when the disease debuts locally&#44; curative treatment is possible&#46; The fundamental pillar of this treatment is surgery with wide resection margins using an extensive&#44; and not marginal&#44; excision&#44; which would involve going through the tumor pseudocapsule &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Associated radiotherapy is administered in cases with high tumor risk &#8211; high histological grade&#44; deep presentations&#44; or larger than 5<span class="elsevierStyleHsp" style=""></span>cm &#8211; and in cases where the tumor resection margin is less than 1<span class="elsevierStyleHsp" style=""></span>cm&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2&#44;3</span></a> The benefit of adjuvant chemotherapy is limited&#44; with little impact on survival compared to the side effects it causes&#46; Recent studies have shown that neoadjuvant chemotherapy is able to improve survival in five types of high-risk sarcomas&#46; Furthermore&#44; it favors the possibility of less aggressive resections and improving the rate of complete resections&#44; which are fundamental for local control of this disease&#44; and to a lesser extent for overall survival&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Given the low frequency and heterogeneity of these tumors&#44; clinical guidelines consider it essential for them to be managed at hospitals specialized in sarcomas with extensive experience in their treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">One of the main stumbling blocks in the management of STS is unplanned resection&#44; or non-oncological resection&#44; which affects approximately 40&#37; of diagnosed cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">6&#44;7</span></a> This type of surgery involves intralesional resection or enucleation through the tumor pseudocapsule&#44; which is not a histological delineation of the tumor but instead a crown of healthy cells from the surrounding tissues infiltrated by the tumor&#46; This phenomenon implies that there is no tissue &#8216;border&#8217; for these tumor cells&#44; and it is associated with a significant increase in local recurrence compared to standardized resections&#46; Zagars et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> published a study whose objective was to document the influence of re-resection in patients with unplanned surgery on the prognosis of the disease&#44; finding that more than 53&#37; of the re-operated patients had residual tumor in the surgical specimen&#46; Reoperation was shown to be a determining factor for the lower local recurrence rate &#40;LR&#41; &#40;85&#37; vs 78&#37;&#41;&#44; longer metastasis-free time and increased disease-specific survival in patients who had undergone previous incomplete surgery&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">When a sarcoma is resected in an unplanned manner&#44; the patient should be sent to a referral hospital for specific management&#46; Once there&#44; the pathology study should be reviewed&#44; the risk of the tumor stratified&#44; an imaging study carried out to determine the feasibility and extent of the new resection&#44; and an extension study&#44; especially if it has been a long time since the first surgery&#46; Clinical guidelines recommend that these cases should always be treated with a second resection providing free margins and adjuvant radiotherapy&#44; whether or not there is evidence of a residual lesion&#44; as it is not possible to predict which patients will have residual tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> Several studies have analyzed the impact of these resections on the rate of LR&#44; distant recurrence and overall survival&#44; demonstrating a clear detriment to local control and functional results&#46; However&#44; the results are less clear in terms of overall survival&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This study retrospectively analyzes the prognostic differences in terms of LR&#44; distant recurrence and survival of patients diagnosed with STS who were treated with unplanned resection at our hospital compared to those who underwent planned surgery&#44; with or without adjuvant treatment&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A retrospective descriptive study was carried out of all the patients treated surgically for STS since 2000 in our service&#46; Patient data was collected from our hospital&#39;s database and medical records archive&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Initially&#44; patients were classified as to whether the first intervention was planned or unplanned&#46; Unplanned resection was defined as one not performed according to established oncological standards&#44; either due to not having a preoperative histological diagnosis&#44; or due to erroneous surgical management &#8211; enucleation or intralesional surgery &#8211; when a benign lesion was suspected as the initial diagnosis&#46; Patients who were referred to our hospital after an unplanned resection were also included&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Age at diagnosis&#44; sex&#44; location&#44; histology&#44; tumor stage&#44; and tumor grade were recorded&#46; Tumor grade is a histological characteristic of aggressiveness related with the risk of metastasis&#46; In our series&#44; we used the grading system of the French Federation of Cancer Centers Sarcoma Group &#40;FFCCSG&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a> Staging was done in accordance with the 7th edition of the American Joint Commission on Cancer for STS and not the 8th&#44; since this latest update had not been published at the time of the review&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the &#8216;unplanned&#8217; group&#44; we recorded whether reoperation had been carried out and whether there was residual tumor in the new surgical specimen&#46; Finally&#44; the rates of local recurrence and metastasis in both groups were compared&#44; both globally and by stages&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical Analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Statistical analysis was conducted with version 24&#46;0 of the SPSS statistical software&#46; The chi squared test was used for the analysis of the variables of this study&#44; and the log rank test for the survival analysis&#46; A <span class="elsevierStyleItalic">P</span> value of &#60;&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">From January 2000 to January 2016&#44; 23 patients with STS were treated with planned resection&#44; and 16 with unplanned resection&#44; 13 of which were reoperated&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The results for sex and location were similar in both groups&#44; and the most frequent location was the lower limbs&#46; The most frequent histology in the unplanned resection group was liposarcoma &#40;25&#37;&#41;&#44; and undifferentiated sarcoma in the planned resection group&#44; reaching 50&#37; when the different subtypes were grouped&#46; Between both groups&#44; more than 11 different histologies were identified &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Distribution by stages &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; was not statistically significant&#44; probably due to a type 2 error as a result of the small sample size&#59; however&#44; the majority of tumors in the unplanned resection group belonged to stages I and II&#46; The demographic and pathological characteristics of both groups are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Reoperation was performed in 13 of the 16 patients who underwent unplanned resection&#59; 100&#37; of these patients presented margin involvement in the first intervention&#44; while 77&#37; of the reoperated patients presented macroscopic residual tumor in the reoperation specimen&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The unplanned resection group underwent a greater number of reoperations &#40;median of 4&#41; and presented worse functional results&#44; with at least three registered limb amputations and one hemipelvectomy&#46; In the unplanned group&#44; 71&#46;4&#37; received some type of radiotherapy treatment &#40;intraoperative radiotherapy vs adjuvant radiotherapy&#41;&#44; versus 85&#37; of the planned group&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Regarding the presence of local or distant recurrence&#44; global and stage analyses were carried out to eliminate the bias conferred by a worse prognosis in tumors with planned resection because they involved more advanced stages&#46; The overall LR rate in the unplanned group was 73&#46;5&#37;&#44; compared to 43&#46;8&#37; in the planned group&#46; All tumors &#40;100&#37;&#41; that had been resected in an unplanned manner and were not reoperated presented LR&#46; The overall metastasis rate in the unplanned group was 45&#46;5&#37;&#44; compared to 56&#46;3&#37; in the planned group&#46; None of these differences was statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#62;&#46;05&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows how local and distant recurrence patterns followed a progressive tumor stage distribution in tumors with planned resection&#46; However&#44; in unplanned cases&#44; the distribution of recurrence was more erratic&#44; and the poor prognosis of tumors at earlier stages in this group is striking&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Likewise&#44; a survival analysis was carried out for LR&#44; metastasis and overall survival&#44; comparing both groups&#46; The median time to LR in the unplanned group was 6 years and in the planned group over 10 years &#40;<span class="elsevierStyleItalic">P</span>&#62;&#46;05&#41;&#46; However&#44; the results were more favorable for the presence of metastases and survival in the group of unplanned patients&#44; and the log-rank comparison for the development of metastases was statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;048&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; We also analyzed whether the LR rate was related to the use of adjuvant or intraoperative radiotherapy&#44; although statistical significance was not reached&#46; However&#44; the median time until LR was 116 months in the group that received radiotherapy and 65 months in the non-treatment group&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">We analyzed the correlation between LR and presence of metastasis and survival&#46; Some 60&#37; of patients with LR presented metastasis at some point&#44; while only 25&#37; of those who did not present LR developed metastasis &#40;in all cases it was an early distant recurrence&#44; within 4 months of diagnosis&#41;&#46; In terms of mortality&#44; 46&#37; of the patients with LR died from the disease&#44; compared to 18&#46;2&#37; of patients who did not have LR &#40;<span class="elsevierStyleItalic">P</span>&#62;&#46;05&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Unplanned resection of STS often compromises the oncological management of these tumors&#44; which require extensive surgery with a margin of at least 1&#8211;3<span class="elsevierStyleHsp" style=""></span>cm&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> This concept was first introduced by Giuliano and Eilber<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> in 1985 as surgery in which an excisional biopsy is performed&#44; or in which the lesion is resected without having completed a proper diagnostic process and without the intention of achieving an adequate margin&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> This situation is frequent because benign soft tissue tumors are much more frequent than sarcomas&#44; and it is the lack of suspicion of a malignant lesion that leads to this error in management&#46; As the literature shows&#44; the majority of sarcomas managed with unplanned resection are small and superficial lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> In our cohort&#44; more than 80&#37; of the unplanned resected tumors measured less than 5<span class="elsevierStyleHsp" style=""></span>cm&#44; and 75&#37; were superficial to the fascia&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">If we refer to the distribution by stages&#44; we see a trend in which most unplanned tumors are stage IIb &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; which corresponds with small tumors of high histological grade&#46; The distribution by stages in the planned group is more homogeneous and also includes a higher percentage of advanced stages&#44; which shows that large lesions are studied more frequently&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Sarcoma histology would also be a risk factor for unplanned resection&#44; since very fatty homogeneous-looking lesions are most often confused with a lipoma or another benign lesion&#46; The Fiore and Lewis series agree that liposarcoma is the most frequently found tumor in the group of unplanned resections&#44; which coincides with our series&#44; where liposarcoma was found in 25&#37; of these cases&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Unplanned sarcoma surgery implies the existence of residual tumor cells in the surgical site that would have lost their anatomical limit&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> This phenomenon has been associated with higher local recurrence rates and worse functional results due to the need for extensive reoperations for local control&#46; In our series&#44; 77&#37; of the reoperated tumors presented residual tumor&#44; and in all of them free margins were achieved during reoperation&#46; However&#44; reoperation could not compensate for the negative effect of unplanned resection&#44; and this group of patients presented an LR rate of 73&#46;5&#37;&#44; compared to 44&#37; in the group that underwent a planned procedure&#46; There is no clear negative impact of unplanned resection on metastasis or survival rates&#44; and&#44; in fact&#44; the survival analysis of our series showed that the unplanned resection group presented better results than the control group&#46; This controversy also appears in the majority of studies in this regard&#44; where the detriment to local control and worse functional results is clear&#44; but where&#44; paradoxically&#44; a higher rate of metastasis is evident in the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> This phenomenon could be explained by the fact that there is no homogeneity in the tumor characteristics of both groups in terms of tumor stage&#46; In a brilliant paper&#44; Hayes et al&#46; addressed this problem using a prognostic analysis stratified by tumor stage between the two groups&#44; demonstrating that in stage III tumors the difference between the metastasis rate and disease-specific survival was significant&#44; with worse results in the unplanned resection group&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> In addition to the different distribution by stages&#44; there are also important differences in location and histology between the two groups&#44; with pathological characteristics for a better prognosis in the unplanned group&#46; In our series&#44; 75&#37; were located superficially and were mainly liposarcomas and pleomorphic sarcomas&#46; Many superficial sarcomas &#8211; dermal pleomorphic sarcoma&#44; atypical lipomatous tumor&#47;well-differentiated liposarcoma&#44; leiomyosarcoma &#8211; are known to be less aggressive than their deep counterparts&#44; especially because of their limited metastatic capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Our review does not demonstrate the influence of LR on the development of metastases or mortality&#44; although their percentages are much higher in patients who presented LR &#40;60&#37; metastasis and 46&#37; mortality&#41;&#46; Larger series have confirmed the hypothesis of the negative repercussions of LR on the prognosis of STS&#44; suggesting that failed local control&#44; with multiple recurrences and reoperations&#44; would ultimately be a determining factor for worse survival due to the direct effect on metastatic spread or the detrimental effect of an LR on a critical anatomical location&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The best strategy to prevent mishandling of STS is to disseminate the concept of how to deal with a soft tissue injury that could potentially be a sarcoma&#46; While it is difficult to clarify the clinical characteristics of this disease&#44; five warning signs have been described that should make us suspect malignancy&#58; rapid growth&#44; size greater than 5<span class="elsevierStyleHsp" style=""></span>cm&#44; painful injury&#44; deep lesion to the fascia and recurrence after excision&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> If any of these characteristics exists&#44; an ultrasound should be performed within 2 weeks&#46; If the ultrasound scan cannot confirm that it is a benign lesion&#44; or if suspicion persists&#44; the patient should be referred to a specialized hospital for an MRI extension study and core needle biopsy&#44; preferably radiology-guided to locate the most heterogeneous areas of the lesion&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">24&#44;25</span></a> The preoperative pathology study is essential to identify the histology and tumor grade in order to guide the treatment plan&#44; which may include neoadjuvant chemotherapy treatment in certain cases&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of Interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">All authors declare that there is no conflict of interests&#46;</p></span></span>"
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    "fechaRecibido" => "2019-04-15"
    "fechaAceptado" => "2019-10-20"
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          "clase" => "keyword"
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            0 => "Soft tissue sarcoma"
            1 => "Unplanned excision"
            2 => "Surgery"
            3 => "Local recurrence"
            4 => "Prognosis"
            5 => "Reintervention"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Sarcoma de partes blandas"
            1 => "Resecci&#243;n no planificada"
            2 => "Cirug&#237;a"
            3 => "Recurrencia local"
            4 => "Pron&#243;stico"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Up to 40&#37; of all initial operations for soft tissue sarcoma &#40;STS&#41; are unplanned&#44; which would leave residual macroscopic tumor in more than 50&#37; of the cases&#46; The effect this has on local recurrence rate&#44; metastases rate and survival has never been fully established&#44; due to the lack of randomized studies&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retrospective review of patients with STS treated in our unit between January 2001-January 2016&#46; We classified them whether they had been treated by initial planned or unplanned operation&#46; Outcomes were compared in both groups globally and stage-matched&#46; Endpoints were local recurrence and distant metastases&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Twenty-three patients of STS underwent a planned excision and 16 an unplanned excision&#44; 13 of them underwent further re-excision&#46; 40&#37; of patients with planned excision had an advanced stage in regard to the unplanned excision group which presented earlier stages&#46; 77&#37; of patients with unplanned excision had residual tumor identified after surgical re-excision&#46; Local recurrence rate in the unplanned excision group was considerably higher 73&#46;5&#37; vs 43&#46;8&#37;&#46; Metastases rate was lower in planned excision group&#44; 45&#46;5&#37; vs 56&#46;3&#37; &#40;<span class="elsevierStyleItalic">P</span>&#62;&#46;05&#41;&#46; The recurrence pattern in the unplanned excision group was unstable&#44; with worse outcomes in earlier stages&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The unplanned excision of a soft tissue sarcoma may compromise disease local control&#44; with higher rates of local recurrence and metastases&#44; and worse functional outcomes&#44; despite further oncological treatment&#46; We need to recognize the clinical features for malignancy risk in soft tissue lumps for a safe diagnosis to avoid inadequate resections&#46;</p></span>"
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            "titulo" => "Methods"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Hasta un 40&#37; de los sarcomas de partes blandas &#40;SPB&#41; son resecados de forma no planificada&#44; dejando tumor residual en m&#225;s del 50&#37; de los casos&#46; La implicaci&#243;n pron&#243;stica de estas resecciones no est&#225; claramente definida&#44; dado que existen escasos estudios comparativos que demuestren c&#243;mo afecta a la tasa de recurrencia local&#44; de met&#225;stasis y de supervivencia&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n retrospectiva de pacientes intervenidos de un SPB de enero de 2000 a enero de 2016 clasific&#225;ndolos respecto a intervenci&#243;n planificada o no planificada&#46; Se compararon las tasas de recurrencia y met&#225;stasis en global y por estadios&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Veintitr&#233;s pacientes con SPB fueron tratados de forma planificada y 16 de forma no planificada&#44; con 13 reintervenciones&#46; El 40&#37; del grupo planificado present&#243; un estadio avanzado respecto al 20&#37; del grupo no planificado&#46; El 77&#37; de los pacientes con resecci&#243;n no planificada reintervenidos presentaron tumor residual en la pieza&#46; La tasa de recidiva local en el grupo de no planificados fue considerablemente m&#225;s alta &#40;73&#44;5&#37; frente al 43&#44;8&#37;&#41;&#46; La tasa de met&#225;stasis en no planificados fue del 45&#44;5&#37;&#44; frente al 56&#44;3&#37; en planificados &#40;p&#62;0&#44;05&#41;&#46; En el grupo de no planificados el patr&#243;n de recidiva fue m&#225;s err&#225;tico con peores resultados en estadios precoces&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Concusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La resecci&#243;n no planificada de los SPB asocia mayores tasas de recurrencia local y peores resultados funcionales a pesar del manejo oncol&#243;gico posterior&#46; En las lesiones de partes blandas es fundamental reconocer los signos de alarma que sugieren malignidad para llevar a cabo un estudio diagn&#243;stico espec&#237;fico y evitar resecciones inadecuadas&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mu&#241;oz Mu&#241;oz P&#44; Bajawi Carretero M&#44; Gonz&#225;lez Barranquero A&#44; Mena Mateos A&#44; Corral Moreno S&#44; Sanjuanbenito Dehesa A&#44; et al&#46; Impacto de la resecci&#243;n no planificada y la reintervenci&#243;n de sarcomas de partes blandas en su pron&#243;stico&#46; Cir Esp&#46; 2020&#59;98&#58;281&#8211;287&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; median &#40;yrs&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66 &#40;13&#8211;84&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;28&#8211;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Location</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Upper limb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lower limb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trunk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other &#40;head and neck&#44; clavicle&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Histology</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leiomyosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Liposarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Undifferentiated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Myxofibrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Synovial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Size</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T1 &#40;&#8804;5&#46;0<span class="elsevierStyleHsp" style=""></span>cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T2 &#40;&#8805;5&#46;1<span class="elsevierStyleHsp" style=""></span>cm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;70&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;82&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Depth</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">9 &#40;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TNM AJCC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>E I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>E II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>E III&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>E IV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>E I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">80&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>E II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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