Rydholm A, Gustafson P, Rööser B, Willén H, Akerman M, Herrlin K, Alvegård T
Department of Orthopedics, University Hospital, Lund, Sweden.
J Clin Oncol. 1991 Oct;9(10):1757-65. doi: 10.1200/JCO.1991.9.10.1757.
From 1980 through 1986, 119 patients with soft tissue sarcomas of the extremities were referred to our tumor center either before surgery (n = 78) or immediately after incisional biopsy or marginal excision (n = 41). The tumors were classified according to anatomic location at admittance as subcutaneous (n = 40), intramuscular (n = 30), and extramuscular tumors (n = 49). Open biopsy was omitted in 75 of the 78 patients referred before surgery; the preoperative diagnosis was based on physical and radiographic findings and fine-needle aspiration cytology. The surgical intention for subcutaneous tumor was to obtain a wide margin, which required a cuff of fat tissue around the tumor and inclusion of the deep fascia beneath the tumor. A wide margin for an intramuscular tumor implied no open biopsy and an unbroken muscle fascia or thick muscle cuff around the tumor (primary myectomy). The 70 patients with subcutaneous and intramuscular tumors were all treated by local surgery. A wide margin was obtained in 56 patients who were not given radiotherapy. During a median follow-up of 5 years (range, 3.5 to 10 years), four of these 56 patients--47 of whom had high-grade malignant tumors--had a local recurrence. We conclude that routine combination of limb-sparing surgery with adjuvant radiotherapy is not necessary in patients with soft tissue sarcoma. Two thirds of soft tissue sarcomas of the extremities are primarily subcutaneous or intramuscular tumors, the majority of which can be treated by local surgery without local adjuvant therapy with a local recurrence rate of less than 10%, irrespective of malignancy grade.
从1980年到1986年，119例肢体软组织肉瘤患者在手术前（n = 78）或切开活检或边缘切除后立即（n = 41）被转诊至我们的肿瘤中心。根据入院时的解剖位置，肿瘤分为皮下肿瘤（n = 40）、肌内肿瘤（n = 30）和肌外肿瘤（n = 49）。78例手术前转诊的患者中有75例未进行开放活检；术前诊断基于体格检查、影像学检查结果和细针穿刺细胞学检查。皮下肿瘤的手术目的是获得广泛切缘，这需要肿瘤周围有一圈脂肪组织并包括肿瘤下方的深筋膜。肌内肿瘤的广泛切缘意味着不进行开放活检，且肿瘤周围的肌肉筋膜完整或有较厚的肌肉袖套（原发性肌肉切除术）。70例皮下和肌内肿瘤患者均接受了局部手术。56例未接受放疗的患者获得了广泛切缘。在中位随访5年（范围3.5至10年）期间，这56例患者中有4例出现局部复发，其中47例为高级别恶性肿瘤。我们得出结论，软组织肉瘤患者无需常规将保肢手术与辅助放疗联合应用。肢体软组织肉瘤的三分之二主要是皮下或肌内肿瘤，其中大多数可通过局部手术治疗，无需局部辅助治疗，局部复发率低于10%，与恶性程度无关。
