Scamporlino Adriana, Ruggiero Ciro, Aramini Beatrice, Morandi Uliano, Stefani Alessandro
Thoracic Surgery Unit, University Hospital of Modena, Modena, Italy.
J Thorac Dis. 2020 May;12(5):1884-1894. doi: 10.21037/jtd-20-649.
Elastofibroma dorsi (ED) is a benign soft-tissue tumor of the chest wall located near the tip of the scapula. Clinical presentation includes swelling, pain and impairment of shoulder movements. The present literature relies only on few small case series. The aim of this study was to analyze the surgical management of ED, focusing on the debated topics regarding preoperative evaluation, operative technique, post-operative outcome and follow-up.
We conducted a single-center retrospective cohort analysis of patients operated for ED between 2003 and 2018. Diagnostic techniques were ultrasonography (US), computed tomography (CT-scan) and magnetic resonance imaging (MRI). CT-scan represented our preferred imaging study for preoperative assessment. Surgery was proposed for symptomatic and/or large lesions. Marginal excision through a muscle-sparing approach was performed. An open-door follow-up policy was adopted. All clinical, radiological, perioperative and pathological variables were matched in a univariate analysis. A multivariate analysis was performed to investigate risk factors for postoperative complications. Correlations analysis between radiological and pathological measurements of elastofibroma was conducted.
Seventy elastofibromas were excised in 59 patients. Mean age was 59 years and female prevalence was 59%. All elastofibromas were completely resected with no recurrence. Postoperative complications rate was 17%. Complications were mild in most cases. At the univariate analysis, patients with body mass index (BMI) >25 had a longer operative time (P=0.048), patients on antiplatelet medications experienced a prolonged drainage time (P=0.006) and a higher rate of complications (P=0.038); the occurrence of complications resulted in prolonged drainage time (P=0.047) and length of stay (P=0.023). A BMI ≤25 was the only independent risk factor for postoperative morbidity (OR 8.71, P=0.024). CT-scan showed the highest correlation with pathological size (r=0.819), US the lowest (r=0.421).
Marginal resection through a muscle-sparing approach is safe and effective for the treatment of ED. CT-scan can be adequate for preoperative assessment. Giving the benign nature of the lesion and the absence of recurrence after complete resection, an open-door follow-up may be appropriate.
背部弹力纤维瘤（ED）是一种位于肩胛骨尖端附近胸壁的良性软组织肿瘤。临床表现包括肿胀、疼痛和肩部活动受限。目前的文献仅依赖于少数小病例系列。本研究的目的是分析ED的手术治疗，重点关注术前评估、手术技术、术后结果和随访等有争议的话题。
我们对2003年至2018年间接受ED手术的患者进行了单中心回顾性队列分析。诊断技术包括超声（US）、计算机断层扫描（CT扫描）和磁共振成像（MRI）。CT扫描是我们术前评估首选的影像学检查。对有症状和/或较大的病变建议手术治疗。采用保留肌肉的方法进行边缘切除。采用开放式随访策略。对所有临床、放射学、围手术期和病理变量进行单因素分析。进行多因素分析以研究术后并发症的危险因素。对弹力纤维瘤的放射学和病理学测量进行相关性分析。
59例患者切除了70个弹力纤维瘤。平均年龄为59岁，女性患病率为59%。所有弹力纤维瘤均完全切除，无复发。术后并发症发生率为17%。大多数情况下并发症较轻。在单因素分析中，体重指数（BMI）>25的患者手术时间较长（P=0.048），服用抗血小板药物的患者引流时间延长（P=0.006）且并发症发生率较高（P=0.038）；并发症的发生导致引流时间延长（P=0.047）和住院时间延长（P=0.023）。BMI≤25是术后发病的唯一独立危险因素（OR 8.71，P=0.024）。CT扫描与病理大小的相关性最高（r=0.819），超声最低（r=0.421）。
采用保留肌肉的方法进行边缘切除治疗ED安全有效。CT扫描足以进行术前评估。鉴于病变的良性性质以及完全切除后无复发，开放式随访可能是合适的。
