Emori Makoto, Hamada Kenichiro, Omori Shinsuke, Joyama Susumu, Tomita Yasuhiko, Hashimoto Nobuyuki, Takami Hiroshi, Naka Norifumi, Yoshikawa Hideki, Araki Nobuhito
Musculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Ann Vasc Surg. 2012 Jul;26(5):693-9. doi: 10.1016/j.avsg.2011.12.003.
Treatment of soft-tissue sarcomas involving the inguinal region remains challenging because of difficulties in achieving wide surgical margins due to anatomical features. The study aimed to analyze the oncologic and functional outcomes of wide resection with vascular reconstruction for inguinal soft-tissue sarcomas.
Three men and seven women were treated for inguinal soft-tissue sarcomas by wide surgical resection with vascular reconstruction.
Arteries and veins were replaced in nine patients, and artery replacement alone was carried out in one patient. Femoral nerve resections were performed in six patients. One patient and five patients developed local recurrence and distant metastases, respectively. Limb salvage was achieved in 9 of 10 patients (90%). Six patients and one patient developed vascular (arterial graft occlusion [n = 1], lymphedema [n = 5]) and nonvascular (hematoma [n = 1]) complications, respectively. Five-year arterial primary patency was 77%. Five-year disease-free and overall survival rates were 45% and 77%, respectively. Functional outcome scores at latest follow-up averaged 87.5% for Musculoskeletal Tumor Society 1993.
En-bloc resection of major critical structures along with tumor and vascular reconstructions using synthetic grafts is a feasible option in limb salvage surgery for inguinal soft-tissue sarcomas.
由于腹股沟区域的解剖结构特点，实现广泛的手术切缘存在困难，因此治疗累及该区域的软组织肉瘤仍然具有挑战性。本研究旨在分析腹股沟软组织肉瘤广泛切除并进行血管重建后的肿瘤学和功能学结果。
10例腹股沟软组织肉瘤患者（3例男性，7例女性）接受了广泛手术切除并进行血管重建。
9例患者进行了动静脉置换，1例患者仅进行了动脉置换。6例患者进行了股神经切除。1例患者发生局部复发，5例患者发生远处转移。10例患者中有9例（90%）实现了保肢。6例患者和1例患者分别出现了血管（动脉移植闭塞[n = 1]，淋巴水肿[n = 5]）和非血管（血肿[n = 1]）并发症。动脉5年一期通畅率为77%。5年无病生存率和总生存率分别为45%和77%。在最新一次随访时，肌肉骨骼肿瘤学会1993年功能结果评分平均为87.5%。
对于腹股沟软组织肉瘤的保肢手术，整块切除主要关键结构并使用人工血管移植物进行肿瘤切除和血管重建是一种可行的选择。
