Perry R R, Venzon D, Roth J A, Pass H I
Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892.
Ann Thorac Surg. 1990 Mar;49(3):363-8; discussion 368-9. doi: 10.1016/0003-4975(90)90239-3.
Indications for chest wall resection of metastatic or locally recurrent sarcoma and for subsequent bony reconstruction are controversial. Twenty-eight patients had chest wall resection for high-grade primary, metastatic, or recurrent sarcoma. In all patients, resection with selective reconstruction of the bony thorax was performed without operative mortality. Since 1980, only patients with four or more ribs resected have had selective bony reconstruction. Follow-up ranged from 8 to 132 months (median follow-up, 42 months). All deaths were related to sarcoma recurrence. The overall actuarial survival rate was 85% at 1 year, 65% at 3 years, and 59% at more than 5 years. The overall actuarial proportion without disease recurrence was 64% at 1 year, 52% at 3 years, and 40% at more than 5 years. There was no significant difference in overall or disease-free survival for patients with primary, metastatic, or recurrent tumors. The most important prognostic factors were positive margins and concomitant pulmonary resection for synchronous lung metastases. These data support aggressive resection to obtain pathologically tumor-free margins for chest wall sarcomas, whether primary, metastatic or recurrent. Reconstruction can be individualized based on the extent of resection.
转移性或局部复发性肉瘤胸壁切除术及后续骨重建的适应证存在争议。28例患者因高级别原发性、转移性或复发性肉瘤接受了胸壁切除术。所有患者均进行了选择性重建胸廓的切除术，无手术死亡病例。自1980年以来，仅对切除4根或更多肋骨的患者进行了选择性骨重建。随访时间为8至132个月（中位随访时间为42个月）。所有死亡均与肉瘤复发有关。1年时的总体精算生存率为85%，3年时为65%，5年以上时为59%。1年时无疾病复发的总体精算比例为64%，3年时为52%，5年以上时为40%。原发性、转移性或复发性肿瘤患者的总生存率或无病生存率无显著差异。最重要的预后因素是切缘阳性和同步肺转移时的同期肺切除术。这些数据支持积极切除以获得胸壁肉瘤病理上的无瘤切缘，无论其为原发性、转移性还是复发性。可根据切除范围进行个体化重建。
