Departments of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon.
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado.
Vet Comp Oncol. 2019 Sep;17(3):354-364. doi: 10.1111/vco.12479. Epub 2019 Jun 2.
The present peer-reviewed veterinary literature contains conflicting information regarding the impact of surgical margin completeness on risk of local tumour recurrence in canine soft tissue sarcoma (STS). This systematic review and meta-analysis was designed to answer the clinical question: "Does obtaining microscopically tumour-free surgical margins reduce risk for local tumour recurrence in canine cutaneous and subcutaneous STS?" A total of 486 citations were screened, 66 of which underwent full-text evaluation, with 10 studies representing 278 STS excisions ultimately included. Cumulatively, 16/164 (9.8%) of completely excised and 38/114 (33.3%) of incompletely excised STS recurred. Overall relative risk of 0.396 (95% confidence interval = 0.248-0.632) was calculated for local recurrence in STS excised with complete margins as compared to STS excised with incomplete margins. Risk of bias was judged to be low for all studies in terms of selection bias and detection bias but high for all studies in terms of performance bias and exclusion bias. The results of the present meta-analysis, coupled with the results of individual previous studies, strongly suggest that microscopically complete surgical margins confer a significantly reduced risk for local tumour recurrence in canine STS. Future studies ideally should adhere to standardized conducting and reporting guidelines to reduce systematic bias.
目前兽医文献中关于手术切缘完整性对犬软组织肉瘤（STS）局部肿瘤复发风险的影响存在相互矛盾的信息。本系统评价和荟萃分析旨在回答临床问题：“获得显微镜下无肿瘤的手术切缘是否会降低犬皮肤和皮下 STS 的局部肿瘤复发风险？”共筛选出 486 条引文，其中 66 条进行了全文评估，最终纳入了 10 项研究，代表了 278 例 STS 切除术。累积结果显示，完全切除的 STS 中有 16/164（9.8%）复发，不完全切除的 STS 中有 38/114（33.3%）复发。与不完全切除的 STS 相比，完全切除的 STS 局部复发的总体相对风险为 0.396（95%置信区间为 0.248-0.632）。所有研究在选择偏倚和检测偏倚方面被认为风险较低，但在实施偏倚和排除偏倚方面均被认为风险较高。本荟萃分析的结果，加上个别先前研究的结果，强烈表明显微镜下完全的手术切缘可显著降低犬 STS 的局部肿瘤复发风险。未来的研究理想情况下应遵循标准化的进行和报告指南，以减少系统偏倚。
