Jeon Dae-Geun, Lee Soo-Yong, Kim Jin-Wook
Department of Orthopaedic Surgery, Korea Cancer Center Hospital, 215-4 Gongneung-Dong, Nowon-Gu, Seoul, Korea.
J Surg Oncol. 2006 Dec 1;94(7):592-8. doi: 10.1002/jso.20607.
It is quite rare but some primary sarcomas of the bone can be misdiagnosed as benign and be treated using intralesional procedures. An unplanned surgical excision occurs when tumors are removed without the appropriate preoperative evaluation and consideration for the need to obtain tumor-free margins. Residual tumor tissue as a result of unplanned excision of soft tissue sarcoma is a risk factor for local recurrence.
Twenty-five patients, undergone unplanned intralesional procedures of lower extremities, were enrolled in this study. There were 22 (88%) cases of osteosarcomas, 2 (8%) MFH of bone and 1 (4%) adamantinoma. Twenty-two (88%) cases had a limb salvage and among them, 4 (18%) cases had local recurrences. Three cases (12%) had amputation without any local event.
Lung metastasis developed in 6 (24%) cases. The CDF 5 year survival for 22 osteosarcoma cases was 65%(confidence interval: 52-82%).
Despite the high recurrence rate, the CDF survival of osteosarcoma cases was comparable to the primary one. Limb salvage procedures are worthwhile in cases whose initial radiographic findings simulate benign lesions, showing favorable response to neoadjuvant chemotherapy. The relative contraindication to the limb salvage is cases with a history of a pathologic fracture and extensive operative fixation.
骨原发性肉瘤较为罕见，但有些可能被误诊为良性，并采用病损内手术进行治疗。当肿瘤在未进行适当的术前评估且未考虑获取无瘤切缘的必要性的情况下被切除时，就会发生意外手术切除。软组织肉瘤意外切除导致的残留肿瘤组织是局部复发的危险因素。
本研究纳入了25例行下肢意外病损内手术的患者。其中骨肉瘤22例（88%），骨恶性纤维组织细胞瘤2例（8%），造釉细胞瘤1例（4%）。22例（88%）进行了保肢手术，其中4例（18%）出现局部复发。3例（12%）接受了截肢手术，未发生任何局部事件。
6例（24%）发生肺转移。22例骨肉瘤患者的5年累积生存率为65%（置信区间：52 - 82%）。
尽管复发率较高，但骨肉瘤病例的累积生存率与原发性骨肉瘤相当。对于初始影像学表现类似良性病变且对新辅助化疗反应良好的病例，保肢手术是值得的。保肢的相对禁忌证是有病理骨折史和广泛手术内固定的病例。
