Definition of the Surgical Case Complexity in the Treatment of Soft Tissue Tumors of the Extremities and Trunk

SIMPLE SUMMARY: Soft tissue tumors are heterogeneous tumor entities that often require surgical intervention for treatment. While some tumors are easy to resect, others require extremely complex, interdisciplinary surgery depending on the tumor type, localization and biological behavior. Up to now, there has not been an instrument able to objectify the complexity of such a surgery; therefore, we attempted to establish a complexity score for the description of soft tissue tumor surgeries. Furthermore, we aimed to categorize surgeries in such a way that patients can be assigned the best treatment such that a cost-effective approach can be taken. ABSTRACT: Background: We intend to establish a complexity score for soft tissue tumor surgeries to compare the complexities of different soft tissue tumor surgeries and to ultimately assign affected patients to appropriate treatments. Methods: We developed a soft tissue tumor complexity score (STS-SCS) based on three pillars: in addition to patient-related factors, tumor biology and surgery-associated parameters were taken into account. The STS-SCS was applied to our sampling group of 711 patients. Results: The minimum STS-SCS was 4, the maximum score was 34 and the average score 11.4 ± 5.9. The scores of patients with malignant diagnoses were notably higher and more widely scattered than those of patients with benign or intermediate malignant tumors. To better categorize the complexities of individual surgeries, we established four categories using the collected data as a reference dataset. Each of the categories contained approximately one-quarter of the registered patients. Discussion: The STS-SCS allows soft tissue tumor surgeries to be retrospectively evaluated for their complexity and forms the basis for the creation of a prospective concept to provide patients with the right intervention in the right geographic location, which can lead to better results and provision of the most cost-effective overall treatment.