Bianchi G, Sambri A, Cammelli S, Galuppi A, Cortesi A, Righi A, Caldari E, Ferrari S, Donati D
Orthopedic Oncology Department, Istituto Ortopedico Rizzoli, via Pupilli 1, Bologna, Italy.
Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy.
Musculoskelet Surg. 2017 Dec;101(3):243-248. doi: 10.1007/s12306-017-0475-y. Epub 2017 Apr 25.
Soft tissue sarcomas are often inappropriately excised; it is, however, still a matter of debate whether the presence of residual disease in the re-excision specimen can affect patients' prognosis. The aim of this study is to investigate the impact of re-excision after unplanned surgery of primary soft tissue sarcomas (STS) of the extremities.
We retrospectively evaluated 452 adults with grade 2-3, localized STS (349 primary and 103 unplanned excisions).
In the re-excision group, a full 43% of the patients had residual tumor. The re-excision group achieved a significantly better outcome in terms of sarcoma-specific survival (SS) (p = 0.002), local recurrence (LR) (p = 0.004) and distant metastasis (DM) (p = 0.028). Residual tumor was associated with a higher risk of DM (p = 0.005).
We confirm that unplanned surgery does not compromise patients' prognosis; scar re-excision guarantees at least the same SS, LR and DM rates compared to STS primarily treated in a referral center. Routine use of radiation therapy after re-excision could improve local control. Distant metastases seem to be negatively affected by the presence of residual tumor, and therefore, the use of CT in deep and large STS is suggested. The main goal is to avoid unplanned surgery by referring suspected lumps (especially deep, large, increasing in size) to a specialist center.
软组织肉瘤常被不恰当切除；然而，再次切除标本中残留疾病的存在是否会影响患者预后仍存在争议。本研究的目的是调查肢体原发性软组织肉瘤（STS）计划外手术后再次切除的影响。
我们回顾性评估了452例2-3级局限性STS的成人患者（349例初次手术和103例计划外切除）。
在再次切除组中，整整43%的患者有残留肿瘤。再次切除组在肉瘤特异性生存（SS）（p = 0.002）、局部复发（LR）（p = 0.004）和远处转移（DM）（p = 0.028）方面取得了显著更好的结果。残留肿瘤与更高的DM风险相关（p = 0.005）。
我们证实计划外手术不会影响患者预后；与在转诊中心接受原发性STS治疗相比，瘢痕再次切除至少能保证相同的SS、LR和DM率。再次切除后常规使用放射治疗可改善局部控制。远处转移似乎受到残留肿瘤的负面影响，因此，建议对深部和大型STS使用CT检查。主要目标是通过将疑似肿块（尤其是深部、大型、体积增大的肿块）转诊至专科中心来避免计划外手术。
