Collin T, Blackburn A V, Milner R H, Gerrand C, Ragbir M
Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Ann R Coll Surg Engl. 2010 May;92(4):326-9. doi: 10.1308/003588410X12628812460056.
This is a 7-year retrospective review summarising the North of England Bone and Soft Tissue Tumour Service's experience of managing 13 cases of groin sarcoma requiring soft tissue flap reconstruction. This study was performed to try to identify where national referral guidelines in sarcoma management had been followed and reasons for any delays. The study also includes outcome data relating to these patients.
A retrospective, case-note review was undertaken using the local sarcoma database to identify appropriate patients.
In nine patients, national referral guidelines were not followed. This resulted in a mean delay of presentation to the multidisciplinary team of 4.4 months. Ten patients had unplanned excision or exploration of tumours before referral. There were no lower limb amputations. All patients with narrow margins or high grade tumours were referred for radiotherapy. Four patients died; three as a result of distant metastases and one as a result of local recurrence.
Despite delays in referral, treatment by wide excision and plastic surgical reconstruction allowed for local control of these tumours with functional limb salvage. Implementation of National Institute for Health and Clinical Excellence (NICE) guidelines and local strategies could improve the expedient management of these patients.
这是一项为期7年的回顾性研究,总结了英格兰北部骨与软组织肿瘤服务中心处理13例需要软组织瓣重建的腹股沟肉瘤的经验。进行这项研究旨在确定肉瘤管理的国家转诊指南的遵循情况以及任何延误的原因。该研究还包括这些患者的预后数据。
使用当地肉瘤数据库进行回顾性病例记录审查,以确定合适的患者。
9例患者未遵循国家转诊指南。这导致平均延迟4.4个月才向多学科团队就诊。10例患者在转诊前进行了计划外的肿瘤切除或探查。没有进行下肢截肢。所有切缘狭窄或肿瘤分级高的患者均被转诊接受放疗。4例患者死亡;3例死于远处转移,1例死于局部复发。
尽管转诊存在延误,但广泛切除并进行整形手术重建的治疗方法能够实现对这些肿瘤的局部控制并保留肢体功能。实施国家卫生与临床优化研究所(NICE)指南和当地策略可能会改善对这些患者的及时管理。