Chandrasekar C R, Wafa H, Grimer R J, Carter S R, Tillman R M, Abudu A
The Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Birmingham B31 2AP, UK.
J Bone Joint Surg Br. 2008 Feb;90(2):203-8. doi: 10.1302/0301-620X.90B2.19760.
We investigated whether our policy of routine re-excision of the tumour bed after an unplanned excision of a soft-tissue sarcoma was justified. Between April 1982 and December 2005, 2201 patients were referred to our hospital with the diagnosis of soft-tissue sarcoma, of whom 402 (18%) had undergone an unplanned excision elsewhere. A total of 363 (16.5%) were included in this study. Each patient was routinely restaged and the original histology was reviewed. Re-excision was undertaken in 316 (87%). We analysed the patient, tumour and treatment factors in relation to local control, metastasis and overall survival. Residual tumour was found in 188 patients (59%). There was thus no residual disease in 128 patients of whom 10% (13) went on to develop a local recurrence. In 149 patients (47%), the re-excision specimen contained residual tumour, but it had been widely excised. Local recurrence occurred in 30 of these patients (20%). In 39 patients (12%), residual tumour was present in a marginal resection specimen. Of these, 46% (18) developed a local recurrence. A final positive margin in a high-grade tumour had a 60% risk of local recurrence even with post-operative radiotherapy. Metastases developed in 24% (86). The overall survival was 77% at five years. Survival was related to the grade of the tumour and the finding of residual tumour at the time of re-excision. We concluded that our policy of routine re-excision after unplanned excision of soft-tissue sarcoma was justified in view of the high risk of finding residual tumour.
我们调查了对于软组织肉瘤意外切除术后常规再次切除瘤床的策略是否合理。1982年4月至2005年12月期间，2201例患者因软组织肉瘤诊断被转诊至我院，其中402例（18%）曾在其他地方接受过意外切除。本研究共纳入363例（16.5%）。对每位患者进行常规再分期并复查原始组织学。316例（87%）患者接受了再次切除。我们分析了与局部控制、转移和总生存相关的患者、肿瘤及治疗因素。188例患者（59%）发现有残留肿瘤。因此，128例无残留病灶的患者中有10%（13例）发生了局部复发。149例患者（47%）的再次切除标本含有残留肿瘤，但已被广泛切除。这些患者中有30例（20%）发生了局部复发。39例患者（12%）的边缘切除标本中有残留肿瘤。其中46%（18例）发生了局部复发。即使术后放疗，高级别肿瘤切缘最终阳性时局部复发风险仍为60%。24%（86例）发生了转移。5年总生存率为77%。生存与肿瘤分级及再次切除时残留肿瘤的发现情况有关。我们得出结论，鉴于发现残留肿瘤的高风险，对于软组织肉瘤意外切除术后常规再次切除的策略是合理的。
