Pretell-Mazzini Juan, Barton Mark D, Conway Sheila A, Temple H Thomas
Department of Orthopaedic Surgery, Musculoskeletal Oncology Division, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL 33136. E-mail address for J. Pretell-Mazzini:
J Bone Joint Surg Am. 2015 Apr 1;97(7):597-603. doi: 10.2106/JBJS.N.00649.
➤ Biopsy, staging, preoperative imaging and planning, as well as surgical treatment of soft-tissue sarcomas, are best carried out in specialized sarcoma centers, with the support of a multidisciplinary tumor board.➤ Tumor bed excision is recommended after most unplanned excisions, with a goal of obtaining complete tumor removal with an appropriately wide margin of resection.➤ The surgical resection area tends to be more extensive during tumor bed excision than during primary resection because of the need to resect potential areas of contamination, resulting in the need for more reconstructive procedures (flaps and skin grafts) and wider radiation fields.➤ Unplanned excisions are associated with an increased rate of local recurrence related to residual disease and positive margins after tumor bed excision, a deep location, and certain histologic subtypes, such as malignant peripheral nerve sheath tumor, myxofibrosarcoma, and dermatofibrosarcoma protuberans.➤ While adjuvant radiation therapy has not been found to mitigate the risk of local recurrence in unplanned excisions, it is generally utilized in the treatment of unplanned excisions as it is in the treatment of primary soft-tissue sarcomas.➤ Given the surgical and oncologic sequelae of unplanned excisions, prevention through the diffusion of concepts by means of provider education on how to approach soft-tissue masses, which can be potential soft-tissue sarcomas, is the best strategy.
➤ 软组织肉瘤的活检、分期、术前影像学检查与规划以及手术治疗，最好在多学科肿瘤专家委员会的支持下，于专业的肉瘤中心进行。
➤ 大多数计划外切除术后建议进行瘤床切除，目标是实现肿瘤的完整切除，并获得足够宽的切缘。
➤ 由于需要切除潜在的污染区域，瘤床切除时的手术切除范围往往比初次切除时更广泛，这就导致需要更多的重建手术（皮瓣和植皮）以及更宽的放疗野。
➤ 计划外切除与瘤床切除后因残留病灶、切缘阳性、肿瘤位置深以及某些组织学亚型（如恶性外周神经鞘瘤、黏液纤维肉瘤和隆突性皮肤纤维肉瘤）导致的局部复发率增加相关。
➤ 虽然辅助放疗尚未被发现可降低计划外切除中局部复发的风险，但在计划外切除的治疗中通常仍会使用，就如同在原发性软组织肉瘤的治疗中一样。
➤ 鉴于计划外切除的手术和肿瘤学后遗症，通过对医疗服务提供者进行关于如何处理可能是潜在软组织肉瘤的软组织肿块的概念传播来进行预防，是最佳策略。
