Incidence of unplanned excisions of soft tissue sarcomas in the Netherlands: A population-based study

Dutch Sarcoma Grp, Annemarie S. Melis, Melissa Vos, Melinda S. Schuurman, Thijs van Dalen, Winan J. van Houdt, Jos A. van der Hage, Yvonne M. Schrage, Lukas B. Been, Johannes B. Bonenkamp, Marc H. A. Bemelmans, Dirk J. Grunhagen, Cornelis Verhoef, Vincent K. Y. Ho*

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

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    Introduction: Timely recognition of soft tissue sarcomas (STS) remains challenging, potentially leading to unplanned excisions (also known as 'whoops procedures'). This population-based study charted the occurrence of unplanned excisions and identified associated patient, tumour, and treatment-related characteristics. Furthermore, it presents an overview of the outcomes and clinical management following an unplanned excision.

    Methods: From the Netherlands Cancer Registry (NCR) database, information was obtained on 2187 adult patients diagnosed with STS in 2016-2019 who underwent surgery. Tumours located in the mediastinum, heart or retroperitoneum were excluded, as well as incidental findings. Differences between patients with planned and unplanned excisions were assessed with chi-square tests and a multivariable logistic regression model.

    Results: Overall, unplanned excisions comprise 18.2% of all first operations for STS, with a quarter of them occurring outside a hospital. Within hospitals, the unplanned excision rate was 14.4%. Unplanned excisions were more often performed on younger patients, and tumours unsuspected of being STS prior to surgery were generally smaller (

    Discussion: Potential improvement in preventing unplanned excisions may be achieved by better compliance to preoperative imaging and referral guidelines, and stimulating continuous awareness of STS among general surgeons, general practitioners and private practices. (C) 2021 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

    Original languageEnglish
    Pages (from-to)994-1000
    Number of pages7
    Issue number5
    Publication statusPublished - May-2022


    • Soft tissue sarcoma
    • Unplanned excision
    • Surgery
    • Whoops procedure
    • IMPACT
    • GRADE

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