Chiappa Antonio, Bertani Emilio, Pravettoni Gabriella, Zbar Andrew Paul, Foschi Diego, Spinoglio Giuseppe, Bonanni Bernardo, Polvani Gianluca, Ambrogi Federico, Cossu Maria Laura, Ferrari Carlo, Venturino Marco, Crosta Cristiano, Bocciolone Luca, Biffi Roberto
1Unit of Innovative Surgical Techniques - European Institute of Oncology, University of Milan, via Ripamonti, 435, 20141 Milan, Italy.
2Division of Hepatobiliary Surgery, European Institute of Oncology, via Ripamonti, 435, 20141 Milan, Italy.
Indian J Surg. 2018 Apr;80(2):154-162. doi: 10.1007/s12262-018-1722-7. Epub 2018 Jan 31.
To analyze treatment and survival in a series of resected patients with primary or recurrent retroperitoneal sarcoma (RPS) treated and prospectively followed at a single institution. Between July 1994 and December 2015, 89 patients (36 M, 53 F; mean age 60 years, range 25-79) were evaluated. For the purpose of analysis, complete resection was defined as removal of gross tumor with histologically confirmed clear resection margins. Eighty-three out of the 89 patients (93%), 46 of whom affected by primary RPS, and 37 by recurrent RPS, underwent surgical exploration. Sixty-two had a grossly and microscopically complete resection. Fifty-three out of 83 patients (64%) underwent removal of contiguous intra-abdominal organs. Preoperative mortality was nil and significant preoperative complications occurred in six cases only (7%). High-grade tumor pointed out to be a significant variable for a worse survival in all 83 patients amenable to undergo surgical resection (57% 5 years survival for low grade vs 14% for high grade; = 0.0004). Among completely resected patients, only histologic grade clearly affected disease-free survival (72% 5 years survival for low grade vs 50% for high grade; = 0.04), while the role of preoperative blood transfusions (67% 5 years survival for non-transfused patients vs 29% for transfused patients; = 0.05) has to be evaluated in connection to patient complexity. Histological grade and recurrence are the most valuable prognostic predictors; in this clinical subset, an aggressive surgical approach in both primary and recurrent RPS is associated with a best long-term survival and disease-free survival.
分析在单一机构接受治疗并进行前瞻性随访的一系列原发性或复发性腹膜后肉瘤（RPS）切除患者的治疗情况和生存情况。1994年7月至2015年12月期间，对89例例患者（36例男性，53例女性；平均年龄60岁，范围25 - 79岁）进行了评估。为了进行分析，完整切除定义为切除肉眼可见肿瘤且组织学证实切缘阴性。89例患者中有83例（93%）接受了手术探查，其中46例为原发性RPS，37例为复发性RPS。62例实现了肉眼和显微镜下的完整切除。83例患者中有53例（64%）切除了相邻的腹腔内器官。术前死亡率为零，仅6例（7%）出现显著的术前并发症。高级别肿瘤被证明是所有83例适合手术切除患者生存较差的一个显著变量（低级别患者5年生存率为57%，高级别患者为14%；P = 0.0004））。在完全切除的患者中，只有组织学分级明显影响无病生存期（低级别患者5年生存率为72%，高级别患者为50%；P = 0.04），而术前输血的作用（未输血患者5年生存率为67%，输血患者为29%；P = 0.05）必须结合患者的复杂情况进行评估。组织学分级和复发是最有价值的预后预测指标；在这个临床亚组中，原发性和复发性RPS采用积极的手术方法与更好的长期生存和无病生存相关。
