Kawaguchi Noriyoshi, Ahmed Adel Refaat, Matsumoto Seiichi, Manabe Jun, Matsushita Yasushi
Department of Orthopedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Clin Orthop Relat Res. 2004 Feb(419):165-72. doi: 10.1097/00003086-200402000-00027.
To clarify the safety margin in excision of bone and soft tissue sarcomas, a new evaluation method for surgical margins was drafted by the Bone and Soft Tissue Committee of the Japanese Orthopaedic Association in 1989. This new evaluation system was applied to 1329 patients with bone and soft tissue sarcomas, of whom 492 were excluded because of insufficient details, leaving 837 patients (901 surgeries) for the current study. Based on the results derived from analyzing these registered surgical margins, predictable safety margins under different conditions could be determined. When preoperative treatment is not done or is ineffective in high-grade sarcoma, a margin greater than 3 cm wide is necessary. When the preoperative modality is effective, a 2-cm wide margin is permissible. However, for recurrent sarcoma, whether low-grade or high-grade, a curative procedure is necessary. For low-grade sarcoma, obtaining an adequate wide margin is essential but partial marginal margins are acceptable at sites where barriers exist. When the margin is insufficient, radiotherapy should be used regardless of the tumor grade. Making a safety margin definitive through this system, an optimum treatment can be obtained and unnecessary adjunctive modalities can be avoided.
为明确骨肉瘤和软组织肉瘤切除时的安全边界，日本矫形外科学会骨与软组织委员会于1989年起草了一种新的手术切缘评估方法。该新评估系统应用于1329例骨肉瘤和软组织肉瘤患者，其中492例因细节不足被排除，剩余837例患者（901次手术）纳入本研究。基于对这些登记的手术切缘分析得出的结果，可以确定不同情况下可预测的安全边界。在高级别肉瘤中，若未进行术前治疗或术前治疗无效，则需要宽度大于3 cm的切缘。若术前治疗有效，则允许2 cm宽的切缘。然而，对于复发性肉瘤，无论低级别还是高级别，都需要进行根治性手术。对于低级别肉瘤，获得足够宽的切缘至关重要，但在存在屏障的部位，部分边缘切缘也是可以接受的。当切缘不足时，无论肿瘤级别如何，均应使用放疗。通过该系统明确安全边界，可获得最佳治疗方案并避免不必要的辅助治疗方式。
