Postoperative Seromas after Soft-Tissue Sarcoma Resection: Natural History and Progression

Introduction: Following wide surgical excision of deep soft-tissue sarcomas, particularly those that are large and underwent preoperative radiation, patients may develop a seroma despite prolonged surgical drain placement. This study aimed to evaluate the natural history of these fluid collections to better counsel patients regarding expectations. Materials and Methods: We reviewed data on 48 patients with seromas after extremity soft-tissue sarcoma resection to determine the natural history of these seromas and which patient and treatment factors are associated with seroma resolution, which was assessed using advanced imaging. KaplanMeier and univariate analyses determined predictors of time to resolution. Alpha=0.05. Results: Twenty patients had complete seroma resolution at a mean (standard error) 50 (7.0) months postoperatively. Complete resolution occurred at higher rates among men (56%) vs. women (24%); patients who did not undergo postoperative radiation (49%) vs. those who did (11%); and patients with initial seroma size <85 cm3 (61%) vs. ≥ 85 cm3 (17%) (all, p<0.05). Factors associated with shorter mean (standard error) time to resolution were upper-extremity involvement (6.2 [2.7] months) vs. lower-extremity involvement (52 [7.2] months); and initial seroma size <85cm 3 (14[1.7] months) vs. ≥ 85 cm3 (76 [7.5] months) (both, p<0.05). Discussion: Most seromas after extremity soft-tissue sarcoma resection shrank over time. Male sex, lack of postoperative radiation, and initial seroma size <85 cm3 were associated with complete resolution. Initial seroma size <85 cm3 were associated with faster resolution.