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The main goal of the treatment of soft tissue sarcomas is achieving wide negative margins to improve local control and prevent a recurrence. The role of radiation therapy (RT) is well-established in sarcomas of the extremities, however, published data on its role in unplanned “Oops” operations are scarce. We report on the effect of RT followed by resection as salvage treatment after unplanned surgery.

Sixty-five patients who had undergone an unplanned resection of a postoperatively diagnosed soft tissue sarcoma were treated with RT and/or surgery and retrospectively evaluated for disease progression. Treatment started with RT in 49 (75.4%) cases, including 8 cases of no further surgery. A repeat wide resection was performed directly after the initial surgery in 16 patients followed by RT in 15 of them. 

The disease recurred in 7 out of 49 (14.3%) patients who received RT first and in 9 out of 16 (56.25%) who underwent reoperation before RT (P= .001). Disease-free progression

was higher in cases of low-grade malignancy (P = .049). The clinical diagnosis of lipoma was associated with better outcome than non-lipoma (P = .034). The presence of residual tumor at reoperation did not impact disease control. Patient age, time between symptom onset and diagnosis, hospital level of initial diagnosis (tertiary versus non-tertiary), anatomic site, tumor size, and margin status at the initial excisional biopsy were not significantly correlated with outcome.

Initiating treatment with RT followed by resection as salvage treatment after an unplanned resection of soft tissue sarcoma improves disease control.