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原发性腹膜后肉瘤根治性切除术后的术后发病率:来自跨大西洋 RPS 工作组的报告。

Postoperative Morbidity After Radical Resection of Primary Retroperitoneal Sarcoma: A Report From the Transatlantic RPS Working Group.

机构信息

Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Center, Department of Surgery, University of Toronto, Toronto, Canada.

Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.

出版信息

Ann Surg. 2018 May;267(5):959-964. doi: 10.1097/SLA.0000000000002250.

Abstract

OBJECTIVE

To investigate the safety of radical resection for retroperitoneal sarcoma (RPS).

BACKGROUND

The surgical management of RPS frequently involves complex multivisceral resection. Improved oncologic outcomes have been demonstrated with this approach compared to marginal excision, but the safety of radical resection has not been shown in a large study population.

METHODS

The Transatlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaborative of sarcoma centers. A combined experience of 1007 consecutive resections for primary RPS from January 2002 to December 2011 was studied retrospectively with respect to adverse events. A weighted organ score was devised to account for differences in surgical complexity. Univariate and multivariate logistic regression analyses were performed to investigate associations between adverse events and number and patterns of organs resected. Associations between adverse events and overall survival, local recurrence, and distant metastases were investigated.

RESULTS

Severe postoperative adverse events (Clavien-Dindo ≥3) occurred in 165 patients (16.4%) and 18 patients (1.8%) died within 30 days. Significant predictors of severe adverse events were age (P = 0.003), transfusion requirements (P < 0.001), and resected organ score (P = 0.042). Resections involving pancreaticoduodenectomy, major vascular resection, and splenectomy/pancreatectomy were found to entail higher operative risk (odds ratio >1.5). There was no impact of postoperative adverse events on overall survival, local recurrence, or distant metastases.

CONCLUSIONS

A radical surgical approach to RPS is safe when carried out at a specialist sarcoma center. High-risk resections should be carefully considered on an individual basis and weighed against anticipated disease biology. There appears to be no association between surgical morbidity and long-term oncologic outcomes.

摘要

目的

探讨腹膜后肉瘤(RPS)根治性切除术的安全性。

背景

RPS 的外科治疗常涉及复杂的多脏器切除术。与边缘切除相比,这种方法可改善肿瘤学结果,但在大样本人群中尚未证明根治性切除术的安全性。

方法

Transatlantic Retroperitoneal Sarcoma Working Group(TARPSWG)是一个国际肉瘤中心协作组织。回顾性研究了 2002 年 1 月至 2011 年 12 月期间 1007 例原发性 RPS 患者的连续切除病例,研究了与不良事件相关的内容。设计了加权器官评分,以说明手术复杂性的差异。采用单因素和多因素逻辑回归分析,研究了不良事件与切除器官的数量和类型之间的关系。分析了不良事件与总生存、局部复发和远处转移之间的关系。

结果

165 例(16.4%)患者发生严重术后不良事件(Clavien-Dindo ≥3),18 例(1.8%)患者术后 30 天内死亡。年龄(P = 0.003)、输血需求(P < 0.001)和切除器官评分(P = 0.042)是严重不良事件的显著预测因素。涉及胰十二指肠切除术、主要血管切除术和脾切除术/胰腺切除术的切除术被认为具有更高的手术风险(优势比>1.5)。术后不良事件对总生存、局部复发或远处转移无影响。

结论

在专业肉瘤中心进行的 RPS 根治性手术是安全的。高危切除术应根据个体情况进行仔细考虑,并权衡预期的疾病生物学。手术发病率与长期肿瘤学结果之间似乎没有关联。

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