XXXX . A pattern of care survey of the American College of Surgeons.

@entity5 @entity1 @entity3 @entity242
A nationwide survey of the clinical presentation, pathology, and management of soft tissue @entity242 in adults was carried out under the auspices of the Commission on @entity5 of the American College of Surgeons. Two separate 2-year periods were used to allow assessment of changes in patterns of care. Data were obtained from 504 hospitals in 1977-1978 (2355 @entity1 ) and 645 institutions in 1983-1984 (3457 @entity1 ). Pretreatment findings of interest included some evidence of physician delay in diagnosis, overuse of excisional biopsy as opposed to the generally preferred approach of incisional biopsy, a low rate of usage of the American Joint Committee for @entity5 Staging (AJCSS) system, and major reliance on CT for pretreatment @entity1 evaluation. Operation was the primary treatment, with or without adjuvant therapies, in approximately three fourths of the @entity1 . The other one fourth were primarily @entity1 with distant @entity3 at the time of diagnosis. Some increase in multimodal therapy did occur in the second period but the rate of amputation was low (approximately 10%) in both periods studied. Survival curves support the prognostic validity of the AJCCS system and the value of complete resection of soft tissue @entity242 . Adverse prognostic factors included positive surgical margins, @entity5 , retroperitoneal or mediastinal primary sites, some histologic types, and the perceived need for adjuvant therapy. @entity1 receiving adjuvant radiation or chemotherapy had less favorable survival data than those treated by operation alone due to criteria used for selecting @entity1 for these therapies. Approximately one half of the treatment failures in the 1977-1978 series were locoregional, whereas 18% were limited to lung @entity3 . Salvage therapy for these two forms of treatment failure yielded 61% and 21% 5-year survival rates.
