ASO Author Reflections: Standardizing Outcome Reporting in Extremity Soft Tissue Sarcoma Flap Reconstruction
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Standardizing Outcome Reporting in Extremity Soft Tissue Sarcoma Flap Reconstruction Anne C. O’Neill, MBBCh, PhD Division of Plastic Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
PAST Flap reconstruction plays an essential role in limb salvage for many patients with extremity soft tissue sarcoma (ESTS), but these complex surgeries are often associated with high postoperative complication rates.1 We previously conducted a comprehensive meta-analysis in an effort to identify predictors of adverse outcomes in ESTS surgery.2 Comparison between studies was severely limited by the heterogeneity in outcome reporting. In particular, the definition and classification of wound complications varied widely between studies. Studies largely considered flap reconstructions and primary closure cases collectively, but we have previously demonstrated that the risk factors for complications differ in these patient cohorts.3 There is a need for high-quality procedure- specific data to enable the development of clinical guidelines to optimize outcomes in ESTS flap surgery. The purpose of this study was to develop and validate a classification system for woundrelated complications following flap reconstruction of ESTS defects to facilitate consistent reporting of outcomes across clinical studies.
primarily based on the direct observation of outcomes in a large cohort of patients at a specialist center but also incorporates complications reported in the existing literature. The TSFS defines and categorizes complications based on the level of treatment intervention required, ensuring objective and unambiguous reporting of outcomes. Validation of the TSFS confirmed excellent intraand interrater reliability {weighted Cohen’s kappa range 0.82 (confidence interval [CI] 0.5–1.0)–0.99 (CI 0.98–1.0) and 0.95 (CI 0.84–1.0)–0.97 (CI 0.92–1.0), respectively}. Further assessment confirmed that the TSFS maintained a high level of interrater reliability across a broad range of surgical specialties and training levels. The vast majority of users agreed that the TSFS was reproducible, objective, and simple to use. FUTURE
Ó Society of Surgical Oncology 2020
It is imperative that studies report outcomes in a consistent and reproducible manner.5 This is particularly important in rare conditions such as ESTS where the identification of optimal treatment strategies requires aggregation and comparison of data from multiple sites. The TSFS has been shown to be a simple and effective tool for the objective classification of outcomes at a single institution, but will now require evaluation at other centers. With further external validation, we believe that the TSFS can become a useful universal tool to facilitate the collection of standardized outcome data from multiple centers, and aid in the establishment of disease-specific standards of care for patients with ESTS who require flap reconstruction.
First Received: 16 September 2020
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