The Safety of Negative-Pressure Wound Therapy in Melanoma and Sarcoma Patients: A Systematic Review.

Background/Objectives: Negative-Pressure Wound Therapy (NPWT) is increasingly used to promote wound healing in chronic and complicated wounds, but its use in surgical oncology is still debated due to theoretical concerns about promoting local tumor recurrence. The aim of this study is to review the available evidence on the oncologic safety of NPWT, specifically regarding the risk of local recurrence in patients undergoing surgery for cutaneous melanoma (CM) or soft tissue sarcoma (STS). Methods: A systematic review of the literature was conducted using the MEDLINE/PubMed, EMBASE, and Scopus databases through December 2024 (PROSPERO: CRD42024623405). Case series, retrospective cohort studies, and randomized clinical trials reporting survival data in melanoma and sarcoma patients treated with NPWT were eligible for inclusion. PRISMA guidelines were followed and quality assessment checked. Results: Seventeen studies were eligible for the analysis with a total of 285 patients, 197 affected by soft tissue sarcoma and 88 by cutaneous melanoma. The pooled proportion of local recurrence was 5% in patients treated with NPWT, regardless of the histology considered (STS and CM). When comparing NPWT to conventional wound therapy, both the pooled risk ratio (0.87; 95% CI: 0.24-3.11; Tau2 = 0.14; I2 = 8%) and odds ratio (0.83; 95% CI: 0.20-3.39; Tau2 = 0.18) indicated no statistically significant difference in the recurrence rate. Conclusions: Current evidence does not suggest an increased risk of local recurrence associated with NPWT in melanoma or sarcoma patients, and mostly, NPWT may have important advantages over standard surgical dressings. More high-power randomized controlled trials with wider follow-up periods are needed to make it possible for practitioners to use this technique without being afraid of higher risk local recurrences.