Theil Christoph, Schneider Kristian Nikolaus, Gosheger Georg, Dieckmann Ralf, Deventer Niklas, Hardes Jendrik, Schmidt-Braekling Tom, Andreou Dimosthenis
Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany.
Department of Orthopedics, Krankenhaus der Barmherzigen Brueder, Nordallee 1, 54292 Trier, Germany.
Cancers (Basel). 2021 May 21;13(11):2510. doi: 10.3390/cancers13112510.
Complications in megaprosthetic reconstruction following sarcoma resection are quite common. While several risk factors for failure have been explored, there is a scarcity of studies investigating the effect of the duration of surgery. We performed a retrospective study of 568 sarcoma patients that underwent megaprosthetic reconstruction between 1993 and 2015. Differences in the length of surgery and implant survival were assessed with the Kaplan-Meier method, the log-rank test and multivariate Cox regressions using an optimal cut-off value determined by receiver operating curves analysis using Youden's index. 230 patients developed a first and 112 patients a subsequent prosthetic failure. The median duration of initial surgery was 210 min. Patients who developed a first failure had a longer duration of the initial surgery (225 vs. 205 min, = 0.0001). There were no differences in the probability of infection between patients with longer and shorter duration of initial surgery (12% vs. 13% at 5 years, = 0.492); however, the probability of mechanical failure was higher in patients with longer initial surgery (38% vs. 23% at 5 years, = 0.006). The median length of revision surgery for the first megaprosthetic failure was 101 min. Patients who underwent first revision for infection and did not develop a second failure had a longer median duration of the first revision surgery (150 min vs. 120 min, = 0.016). A shorter length of the initial surgery appears beneficial, however, the notion that longer operating time increases the risk of deep infection could not be reproduced in our study. In revision surgery for infection, a longer operating time, possibly indicating a more thorough debridement, appears to be associated with a lower risk for subsequent revision.
肉瘤切除术后使用大型假体重建的并发症相当常见。虽然已经探讨了一些失败的风险因素，但研究手术时间影响的研究却很少。我们对1993年至2015年间接受大型假体重建的568例肉瘤患者进行了一项回顾性研究。使用Kaplan-Meier方法、对数秩检验和多变量Cox回归评估手术时间和植入物存活率的差异，使用由Youden指数通过受试者工作曲线分析确定的最佳临界值。230例患者首次出现假体失败，112例患者随后出现假体失败。初次手术的中位时间为210分钟。首次出现失败的患者初次手术时间更长（225分钟对205分钟，P = 0.0001）。初次手术时间较长和较短的患者感染概率没有差异（5年时分别为12%对13%，P = 0.492）；然而，初次手术时间较长的患者机械性失败的概率更高（5年时分别为38%对23%，P = 0.006）。首次大型假体失败的翻修手术中位时间为101分钟。因感染进行首次翻修且未出现第二次失败的患者首次翻修手术的中位时间更长（150分钟对120分钟，P = 0.016）。较短的初次手术时间似乎是有益的，然而，手术时间延长会增加深部感染风险这一观点在我们的研究中无法得到证实。在因感染进行的翻修手术中，较长的手术时间可能表明清创更彻底，似乎与后续翻修风险较低相关。
