Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON.
Curr Oncol. 2013 Jun;20(3):e247-54. doi: 10.3747/co.20.1308.
In limb salvage surgery for extremity soft-tissue sarcoma (sts), what is an adequate surgical margin?What is the appropriate number of samples to take from the margins of a surgical resection specimen?What is the appropriate handling of surgical resection specimens?
Surgery is the primary treatment for extremity sts. The combination of radiotherapy with surgery allows for limb salvage by using radiation to biologically "sterilize" microscopic extensions of tumour and to spare neurovascular and osseous structures. Adjuvant chemotherapy in sts-except for rhabdomyosarcoma and Ewing sarcoma-continues to be controversial.
The medline and embase databases (1975 to June 2011) and the Cochrane Library were searched for pertinent studies. The Web sites of the main guideline organizations and the American Society of Clinical Oncology conference proceedings (2007-2010) were also searched.
Thirty-three papers, including four guidelines, one protocol, and one abstract, were eligible for inclusion. The data suggest that patients with clear margins have a better prognosis, but no prospective studies have indicated how wide margins should be. In limb-salvage surgery for extremity sts, the procedure should be planned to achieve a clear margin. However, to preserve functionality, surgery may result in a very close (<1 cm) or even microscopically positive margin. In this circumstance, the use of preoperative or postoperative radiation should be considered. No studies described the optimal number of tissue sections required to assess adequacy of excision nor the appropriate handling of surgical resection specimens. The Sarcoma Disease Site Group made its recommendations based on expert opinion and consensus.
在肢体软组织肉瘤（STS）的保肢手术中，什么是足够的手术切缘？从手术切除标本的切缘应取多少个样本？如何妥善处理手术切除标本？
手术是肢体 STS 的主要治疗方法。放疗与手术相结合，通过放射使肿瘤的微观延伸部分生物学“绝育”，并保护神经血管和骨骼结构，从而允许保肢。STS 中的辅助化疗（横纹肌肉瘤和尤文肉瘤除外）仍存在争议。
检索了 medline 和 embase 数据库（1975 年至 2011 年 6 月）和 Cochrane 图书馆，搜索了相关研究。还搜索了主要指南组织的网站和美国临床肿瘤学会会议记录（2007-2010 年）。
有 33 篇论文，包括 4 个指南、1 个方案和 1 个摘要，符合纳入标准。这些数据表明，切缘清晰的患者预后更好，但没有前瞻性研究表明切缘应多宽。在肢体软组织肉瘤的保肢手术中，手术应计划实现清晰的切缘。然而，为了保留功能，手术可能导致非常接近（<1cm）或甚至显微镜下阳性的切缘。在这种情况下，应考虑术前或术后放疗。没有研究描述评估切除充分性所需的最佳组织切片数量，也没有描述手术切除标本的适当处理方法。肉瘤疾病部位小组根据专家意见和共识提出了建议。
