Klinik für Allgemein- und Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstrasse 5, 40225 Düsseldorf, Germany.
World J Surg. 2009 Dec;33(12):2599-605. doi: 10.1007/s00268-009-0262-5.
Assuming a benign tumor, soft tissue sarcomas are often treated by inadequate resection. The concept of reexcision in these patients is still under debate. Therefore, it was our goal to evaluate the results of this treatment with particular respect to residual tumor.
During a 14-year period, a total of 143 patients were referred to Heinrich-Heine-University Düsseldorf and the University of Hamburg [corrected] after unplanned excision. Reexcision was performed in 139 patients. The assessed endpoints were local recurrence-free survival, distant metastasis-free survival, and tumor-related mortality. Univariate and multivariate analyses were performed using a log-rank test and Cox's proportional-hazard models.
Over a median observation period of 109 months, local recurrence appeared in 18 patients (12%) and distant metastasis in 46 patients (33%). Residual tumor was detected in 43 patients (31%) and was significantly associated with reduced relapse-free and overall survival. Local recurrence, however, was not affected.
Despite an incomplete initial resection, reexcision enables local control similar to that in patients without residual tumor. Still, these patients have a worse prognosis owing to an increased rate of distant metastasis; therefore, patients with soft tissue masses of unknown identity should be transferred to centers that specialize in treating sarcomas for adequate initial resection.
假设为良性肿瘤，软组织肉瘤常因切除不充分而治疗。这些患者的再次切除的概念仍存在争议。因此，我们的目标是特别关注残留肿瘤来评估这种治疗的结果。
在 14 年期间，共有 143 名患者在计划外切除后被转诊到杜塞尔多夫海因里希-海涅大学和汉堡大学[更正]。139 名患者进行了再次切除术。评估的终点是无局部复发生存率、无远处转移生存率和肿瘤相关死亡率。使用对数秩检验和 Cox 比例风险模型进行单因素和多因素分析。
在中位数为 109 个月的观察期内，18 名患者（12%）出现局部复发，46 名患者（33%）出现远处转移。43 名患者（31%）检测到残留肿瘤，与降低无复发生存率和总生存率显著相关。然而，局部复发并未受到影响。
尽管初始切除不完全，再次切除仍能实现类似于无残留肿瘤患者的局部控制。尽管如此，由于远处转移率的增加，这些患者的预后较差；因此，对于身份不明的软组织肿块患者，应将其转至专门治疗肉瘤的中心进行充分的初始切除。
