Arvinius Camilla, Torrecilla Elías, Beano-Collado Joaquín, García-Coiradas Javier, García-Maroto Roberto, Puerto-Vázquez María, Cebrián-Parra Juan Luis
Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040, Madrid, Spain.
, Calle Gaztambide 60, 6B, 28015, Madrid, Spain.
Eur J Orthop Surg Traumatol. 2017 Aug;27(6):837-841. doi: 10.1007/s00590-017-1968-y. Epub 2017 May 23.
Well-differentiated liposarcomas of the extremities are one of the most frequent types of malignant soft tissue tumors in adults. These tumors are typically locally aggressive and show a tendency to recurrence after surgical excision even though they do not metastasize and very rarely dedifferentiate. Its clinical presentation is generally a progressively growing mass causing aesthetic, functional, or compressive symptoms depending on the tumor's size and localization. Several authors recommend a wide excision with free margins in order to minimize the risk of recurrence, while others report good results and a low rate of recurrence with more conservative or even marginal excision thereby avoiding complications due to surgical site morbidity. We present a retrospective study of 11 patients with a large-sized well-differentiated liposarcoma of the lower limb with a mean follow-up of 3.2 years. The mean size was 22 × 19 × 17 cm, and a marginal resection was made, respecting the affected neurovascular structures, in all cases. Only one recurrence was found and the functional results were 81.6% according to the MSTS functional scale 1 year after surgery. We believe that the marginal excision is a good alternative when the tumor is located near vascular or nerve structures, and as to our experience, it is not associated with elevated recurrences.
肢体高分化脂肪肉瘤是成人最常见的恶性软组织肿瘤类型之一。这些肿瘤通常具有局部侵袭性，即使不发生转移且极少去分化，但手术切除后仍有复发倾向。其临床表现通常为逐渐增大的肿块，根据肿瘤的大小和部位可引起美观、功能或压迫症状。几位作者建议进行切缘阴性的广泛切除，以尽量降低复发风险，而另一些作者报告称，采用更保守甚至边缘性切除也能取得良好效果且复发率较低，从而避免因手术部位并发症导致的问题。我们对11例下肢大型高分化脂肪肉瘤患者进行了一项回顾性研究，平均随访3.2年。平均大小为22×19×17厘米，所有病例均进行了边缘性切除，同时保留了受影响的神经血管结构。术后1年，根据MSTS功能量表评估，仅发现1例复发，功能结果良好率为81.6%。我们认为，当肿瘤位于血管或神经结构附近时，边缘性切除是一种不错的选择，根据我们的经验，它不会导致复发率升高。
