Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Department of Orthopaedic Surgery, Spartanburg Regional Healthcare System, Spartanburg, SC 29303, USA.
Int J Surg Oncol. 2020 Dec 7;2020:8374790. doi: 10.1155/2020/8374790. eCollection 2020.
Inadvertent excision of a soft tissue sarcoma during hernia surgery is a preventable clinical scenario that leads to unnecessary patient morbidity. Prior series are few, which only include male patients with little focus on prevention. The purpose of this study is to report the presenting features and outcomes of both male and female patients who underwent inadvertent inguinal sarcoma excision during hernia surgery.
A retrospective analysis of a single sarcoma referral center identified 33 patients who were referred for definitive treatment. Patients were divided into three clinically relevant groups based on intraoperative diagnosis, sex, and location of the mass relative to the inguinal ligament. -tests and Fisher's exact tests were performed to compare continuous and categorical variables, respectively. Kaplan-Meier modeling was performed to assess sarcoma-specific survival.
Females were younger (47 years vs. 61 years, =0.003) and had smaller sarcomas (6.7 cm vs. 11 cm, =0.012) compared to males. Only two sarcomas (2/33, 6%) were <4 cm in size. The majority of sarcomas in females were above the inguinal ligament (12/14, 86%). Twenty-nine (88%) underwent definitive R0 excision. The mean number of surgeries per patient was three (range 1-13), with nineteen (58%) patients requiring flap reconstruction and six (18%) requiring vascular bypass. Five patients locally recurred (15%) at a mean of 38 months after definitive excision (range 5-128 months). Overall sarcoma-specific disease-free survival was 64%, with no difference between males (80 ± 11%) and females (59 ± 17%) (=0.885). Mean follow-up was 75 months (range 5-212).
This is the second largest study regarding inadvertent inguinal sarcoma excision and the first to include females. When a suspected hernia is >4 cm, irreducible, firm, and is growing, especially in females, consider obtaining preoperative advanced three-dimensional imaging (CT or MRI) that can differentiate a neoplasm from a hernia.
在疝手术中意外切除软组织肉瘤是一种可预防的临床情况，会导致患者不必要的发病。先前的研究很少，且只包括男性患者，很少关注预防措施。本研究旨在报告在疝手术中意外切除腹股沟肉瘤的男性和女性患者的临床表现和结局。
对单一肉瘤转诊中心进行回顾性分析，确定了 33 名接受确定性治疗的患者。根据术中诊断、性别以及肿块相对于腹股沟韧带的位置，将患者分为三组。采用卡方检验和 Fisher 确切概率法比较连续变量和分类变量。采用 Kaplan-Meier 模型评估肉瘤特异性生存情况。
女性患者更年轻（47 岁比 61 岁，=0.003），肉瘤更小（6.7cm 比 11cm，=0.012）。只有两个肉瘤（2/33，6%）<4cm。女性中大多数肉瘤位于腹股沟韧带上方（12/14，86%）。29 例（88%）接受了确定性 R0 切除。每位患者的平均手术次数为 3 次（范围 1-13 次），19 例（58%）患者需要皮瓣重建，6 例（18%）患者需要血管旁路。5 例患者（15%）在确定性切除后平均 38 个月（范围 5-128 个月）局部复发。总体肉瘤特异性无病生存为 64%，男性（80±11%）和女性（59±17%）之间无差异（=0.885）。平均随访时间为 75 个月（范围 5-212 个月）。
这是第二大关于意外切除腹股沟肉瘤的研究，也是第一个包括女性的研究。当可疑疝>4cm、不可还原、坚硬且在增长时，尤其是女性，应考虑术前进行高级三维成像（CT 或 MRI），以区分肿瘤和疝。
