Paz I B, Wagman L D, Terz J J, Chandrasekhar B, Lorant J A, Moscarello G M, Odom-Maryon T
Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, Calif. 91010.
Arch Surg. 1992 Nov;127(11):1278-81. doi: 10.1001/archsurg.1992.01420110020005.
From 1980 to 1991, 29 patients underwent complex reconstruction following extremity sarcoma resection. Soft tissue was the site of origin in 15 patients (52%) and bone was the site of origin in 14 patients (48%), with 20 sarcomas (69%) in the lower extremity. Resection consisted of the following procedures: extended anatomical soft-tissue resections (21 patients [72%]), bone resections (18 patients [62%]), and joint resections (14 patients [48%]). Reconstruction involved the following: myocutaneous flaps (20 patients [69%]), joint prosthesis (eight patients [28%]), and bone reconstruction (15 patients [52%]). There was no surgical mortality; one patient required an amputation owing to surgical complications. The site of the first failure was local (four [31%] of 13 patients), lung (five patients [38%]), others (four patients [31%]). At a median follow-up of 23 months, 18 patients (62%) had no evidence of disease, 27 (93%) had no local disease, 21 (72%) had good extremity function, three (10%) had major disabilities, and five (17%) underwent amputations. Local control improved when the margin of resection was larger than 10 mm. Disease-free survival was 67% at 3 years. Overall survival was 51% at 5 years. Tumor size was an independent predictor of overall survival. Local recurrence did not affect overall survival.
1980年至1991年期间，29例患者在肢体肉瘤切除术后接受了复杂重建。15例患者（52%）起源于软组织，14例患者（48%）起源于骨骼，其中20例肉瘤（69%）位于下肢。切除包括以下手术：扩大的解剖性软组织切除（21例患者[72%]）、骨切除（18例患者[62%]）和关节切除（14例患者[48%]）。重建涉及以下方面：肌皮瓣（20例患者[69%]）、关节假体（8例患者[28%]）和骨重建（15例患者[52%]）。无手术死亡；1例患者因手术并发症需要截肢。首次复发部位为局部（13例患者中的4例[31%]）、肺部（5例患者[38%]）、其他部位（4例患者[31%]）。中位随访23个月时，18例患者（62%）无疾病证据，27例（93%）无局部疾病，21例（72%）肢体功能良好，3例（10%）有严重残疾，5例（17%）接受了截肢。当切除边缘大于10 mm时，局部控制得到改善。3年无病生存率为67%。5年总生存率为51%。肿瘤大小是总生存的独立预测因素。局部复发不影响总生存。
