Yildiz Cemil, Erler Kaan, Bilgiç Serkan, Ateşalp A Sabri, Başbozkurt Mustafa
Department of Orthopedics and Traumatology, Gülhane Military School of Medicine, Ankara, Turkey.
Acta Orthop Traumatol Turc. 2003;37(5):359-67.
We evaluated the effects of surgical margins and other prognostic factors on local control and survival in extremity soft tissue sarcomas.
The study included 40 patients (34 males, 6 females; mean age 45 years; range 13 to 77 years) who underwent treatment for extremity soft tissue sarcomas. Of these, 14 patients presented with recurrences following treatment elsewhere. Preoperatively, nine patients and eight patients; postoperatively, 35 patients and 25 patients received radiotherapy and chemotherapy, respectively. Limb-salvaging surgery was performed in 35 patients (87.5%), of whom 28 patients (70%) received an extended resection, and seven patients received a marginal resection. Five patients (12.5%) required amputation. Negative surgical margins were achieved in 34 patients (85%), while six patients (15%) had positive surgical margins. The mean follow-up period was 58 months (range 13 to 124 months).
Five patients (12.5%) developed local recurrences following marginal resection (n=4), and amputation. No local recurrences were seen in patients receiving an extended resection or in those having negative surgical margins. Five-year survival rates were 51% and 49% in patients whose initial diagnoses were made in our department and elsewhere, respectively. Significant correlations were found between extended resection (p=0.0001) and negative surgical margins (p=0.0001) and local control; and between tumor grade and survival (p=0.002). Positive surgical margins and local recurrences did not decrease survival.
Achievement of negative surgical margins promotes local control in extremity soft tissue sarcomas. A careful preoperative planning and utilization of neoadjuvant therapies highly increase the possibility of negative surgical margins.
我们评估了手术切缘及其他预后因素对肢体软组织肉瘤局部控制和生存的影响。
该研究纳入了40例接受肢体软组织肉瘤治疗的患者（男性34例，女性6例；平均年龄45岁；范围13至77岁）。其中，14例患者在其他地方接受治疗后出现复发。术前，分别有9例和8例患者；术后，分别有35例和25例患者接受了放疗和化疗。35例患者（87.5%）接受了保肢手术，其中28例患者（70%）接受了扩大切除，7例患者接受了边缘切除。5例患者（12.5%）需要截肢。34例患者（85%）实现了阴性手术切缘，而6例患者（15%）手术切缘阳性。平均随访期为58个月（范围13至124个月）。
边缘切除（n = 4）及截肢后，5例患者（12.5%）出现局部复发。接受扩大切除或手术切缘阴性的患者未出现局部复发。在本科室和其他地方初诊的患者，5年生存率分别为51%和49%。扩大切除（p = 0.0001）、阴性手术切缘（p = 0.0001）与局部控制之间存在显著相关性；肿瘤分级与生存之间存在显著相关性（p = 0.002）。手术切缘阳性和局部复发并未降低生存率。
实现阴性手术切缘可促进肢体软组织肉瘤的局部控制。仔细的术前规划和新辅助治疗的应用可大大提高获得阴性手术切缘的可能性。
