Puhaindran Mark E, Steensma Matthew R, Athanasian Edward A
Department of Surgery, Orthopaedic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Hand Surg Am. 2010 Feb;35(2):291-5. doi: 10.1016/j.jhsa.2009.11.014.
Hand amputations cause marked functional loss for patients. In patients with large soft tissue sarcomas of the hand, partial hand preservation is extremely challenging for surgeons attempting a complete resection of the tumor with negative resection margins. We conducted this review to examine the oncologic outcome, including local recurrence rate and patient overall survival, and functional outcome after resections for large soft tissue sarcomas with partial hand preservation.
We performed a retrospective review of all patients with soft tissue sarcomas of the hand treated at our institution from 1995 to 2007. We identified 8 patients who had tumors at least 5 cm in maximum dimension and had tumor resection with partial hand preservation. The mean age at the time of surgery was 49 years (range, 10-80 years). Two patients had myxofibrosarcoma, 2 patients had synovial sarcoma, 2 patients had malignant fibrous histiocytoma, 1 patient had a malignant peripheral nerve sheath tumor, and 1 patient had a liposarcoma. Two patients had low-grade tumors, and 6 patients had high-grade tumors. Two patients had American Joint Committee on Cancer stage 1b tumors, and 6 patients had American Joint Committee on Cancer stage 3 tumors. No patients had distant metastases at the time of surgery. Hand function was evaluated using Musculoskeletal Tumor Society criteria.
Of the 8 patients, 1 died of distant metastatic disease, 1 developed local tumor recurrence and is alive with locally recurrent disease, and the other 6 patients are completely disease-free. The mean Musculoskeletal Tumor Society score was 26 (range, 19-29), with the 2 patients who had received double-ray amputations having the lower scores (19 and 24).
Partial hand preservation is possible in selected patients with large soft tissue sarcomas of the hand, obtaining low local recurrence rates, good overall survival, and good functional outcome. However, all effort should be made to achieve negative resection margins.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
手部截肢会给患者带来明显的功能丧失。对于患有手部大型软组织肉瘤的患者，对于试图完整切除肿瘤且切缘阴性的外科医生而言，部分手部保留极具挑战性。我们进行此项综述以研究肿瘤学结局，包括局部复发率和患者总生存率，以及手部部分保留的大型软组织肉瘤切除术后的功能结局。
我们对1995年至2007年在本机构接受治疗的所有手部软组织肉瘤患者进行了回顾性研究。我们确定了8例最大直径至少为5 cm且进行了手部部分保留的肿瘤切除患者。手术时的平均年龄为49岁（范围10 - 80岁）。2例患有黏液纤维肉瘤，2例患有滑膜肉瘤，2例患有恶性纤维组织细胞瘤，1例患有恶性外周神经鞘瘤，1例患有脂肪肉瘤。2例为低级别肿瘤，6例为高级别肿瘤。2例患者为美国癌症联合委员会1b期肿瘤，6例患者为美国癌症联合委员会3期肿瘤。手术时无患者发生远处转移。使用肌肉骨骼肿瘤学会标准对手部功能进行评估。
8例患者中，1例死于远处转移性疾病，1例发生局部肿瘤复发且仍存活，患有局部复发性疾病，其他6例患者无疾病。肌肉骨骼肿瘤学会的平均评分为26分（范围19 - 29分），接受双手截肢的2例患者得分较低（19分和24分）。
对于部分选定的手部大型软组织肉瘤患者，手部部分保留是可行的，可获得较低的局部复发率以及良好的总生存率和功能结局。然而，应尽一切努力实现阴性切缘。
研究类型/证据水平：治疗性IV级。
