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脊柱复发性脊索瘤手术切除后的结果:单机构经验

Results following surgical resection of recurrent chordoma of the spine: experience in a single institution.

作者信息

Chanplakorn Pongsthorn, Lertudomphonwanit Thamrong, Homcharoen Wittawat, Suwanpramote Prakrit, Laohacharoensombat Wichien

机构信息

Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.

Department of Orthopedics, Prapokklao Hospital, 38 Leab Noen Rd, Tambon Wat Mai, Mueang Chanthaburi District, Chanthaburi, 22000, Thailand.

出版信息

World J Surg Oncol. 2020 Aug 27;18(1):228. doi: 10.1186/s12957-020-02005-4.

Abstract

BACKGROUND

Chordoma of the spine is a low-grade malignant tumor with vague and indolent symptoms; thus, large tumor mass is encountered at the time of diagnosis in almost cases and makes it difficult for en-bloc free-margin resection. Salvage therapy for recurrent chordoma is very challenging due to its relentless nature and refractory to adjuvant therapies. The aim of this present study was to report the oncologic outcome following surgical resection of chordoma of the spine.

MATERIALS AND METHODS

Retrospective review of 10 consecutive cases of recurrent chordoma patients who underwent surgical treatment between 2003 and 2018 at one tertiary-care center was conducted.

RESULTS

There were 10 patients; 4 females and 6 males were included in this study. Eight patients had local recurrence. The recurrence was encountered at the muscle, surrounding soft tissue, and remaining bony structure. Distant metastases were found in 2 patients. The median time to recurrence or metastasis was 30 months after first surgery.

CONCLUSION

En-bloc free-margin resection is mandatory to prevent recurrence. The clinical vigilance and investigation to identify tumor recurrent should be performed every 3 to 6 months, especially in the first 30 months and annually thereafter. Detection of recurrent in early stage with a small mass may be the best chance to perform an en-bloc margin-free resection to prevent further recurrence.

摘要

背景

脊柱脊索瘤是一种低度恶性肿瘤,症状模糊且进展缓慢;因此,几乎所有病例在诊断时肿瘤体积都很大,这使得整块切缘阴性切除变得困难。复发性脊索瘤的挽救治疗极具挑战性,因为其病程顽固且对辅助治疗耐药。本研究的目的是报告脊柱脊索瘤手术切除后的肿瘤学结果。

材料与方法

对2003年至2018年期间在一家三级医疗中心接受手术治疗的10例复发性脊索瘤患者进行回顾性研究。

结果

本研究共纳入10例患者,其中女性4例,男性6例。8例患者出现局部复发,复发部位为肌肉、周围软组织和残留骨结构。2例患者发生远处转移。首次手术后复发或转移的中位时间为30个月。

结论

必须进行整块切缘阴性切除以预防复发。应每3至6个月进行临床监测和检查以识别肿瘤复发,尤其是在最初的30个月内,此后每年进行一次。在早期发现小肿块复发可能是进行整块切缘阴性切除以防止进一步复发的最佳时机。

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