Slump J, Ferguson P C, Wunder J S, Griffin A M, Hoekstra H J, Liu X, Hofer S O P, O'Neill A C
Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada.
University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada.
Eur J Surg Oncol. 2017 Jun;43(6):1126-1133. doi: 10.1016/j.ejso.2017.01.016. Epub 2017 Feb 8.
Flap reconstruction plays an essential role in the management of soft tissue sarcoma, facilitating wide resection while maximizing preservation of function. The addition of reconstruction increases the complexity of the surgery and identification of patients who are at high risk for post-operative complications is an important part of the preoperative assessment. This study examines predictors of complications in these patients.
294 patients undergoing flap reconstruction following sarcoma resection were evaluated. Data on patient, tumour and treatment variables as well as post-operative complications were collected. Bivariate and multivariate regression analysis was performed to identify independent predictors of complications. Analysis of synergistic interaction between key patient and tumour risk factors was subsequently performed.
A history of cerebrovascular events or cardiac disease were found to be the strongest independent predictors of post-operative complications (OR 14.84, p = 0.003 and OR 5.71, p = 0.001, respectively). Further strong independent tumour and treatment-related predictors were high grade tumours (OR 1.91, p = 0.038) and the need for additional reconstructive procedures (OR 2.78, p = 0.001). Obesity had significant synergistic interaction with tumour resection diameter (RERI 1.1, SI 1.99, p = 0.02) and high tumour grade (RERI 0.86, SI 1.5, p = 0.01). Comorbidities showed significant synergistic interaction with large tumour resections (RERI 0.91, SI 1.83, p = 0.02).
Patient, tumour and treatment-related variables contribute to complications following flap reconstruction of sarcoma defects. This study highlights the importance of considering the combined effect of multiple risk factors when evaluating and counselling patients as significant synergistic interaction between variables can further increase the risk of complications.
皮瓣重建在软组织肉瘤的治疗中起着至关重要的作用，有助于进行广泛切除，同时最大限度地保留功能。重建的加入增加了手术的复杂性，识别术后并发症高风险患者是术前评估的重要组成部分。本研究探讨了这些患者并发症的预测因素。
对294例肉瘤切除术后接受皮瓣重建的患者进行评估。收集患者、肿瘤和治疗变量以及术后并发症的数据。进行双变量和多变量回归分析以确定并发症的独立预测因素。随后对关键患者和肿瘤风险因素之间的协同相互作用进行分析。
脑血管事件或心脏病史被发现是术后并发症最强的独立预测因素（分别为OR 14.84，p = 0.003和OR 5.71，p = 0.001）。其他强烈的独立肿瘤和治疗相关预测因素是高级别肿瘤（OR 1.91，p = 0.038）和需要额外的重建手术（OR 2.78，p = 0.001）。肥胖与肿瘤切除直径（RERI 1.1，SI 1.99，p = 0.02）和高肿瘤分级（RERI 0.86，SI 1.5，p = 0.01）有显著的协同相互作用。合并症与大肿瘤切除有显著的协同相互作用（RERI 0.91，SI 1.83，p = 0.02）。
患者、肿瘤和治疗相关变量导致肉瘤缺损皮瓣重建后的并发症。本研究强调了在评估和咨询患者时考虑多个风险因素综合作用的重要性，因为变量之间显著的协同相互作用会进一步增加并发症的风险。
