Kekeç Ahmet Fevzi, Günaydın İlknur, Öztürk Recep, Güngör Bedii Şafak
Meram Faculty of Medicine, Department of Orthopaedics and Traumatology, Necmettin Erbakan University, Konya, Turkey.
Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Indian J Surg Oncol. 2022 Jun;13(2):395-402. doi: 10.1007/s13193-021-01476-5. Epub 2021 Nov 22.
Bone and soft tissue sarcomas of lower and upper extremities may sometimes be in close contact with neurovascular structures. In such cases, it is controversial that whether en bloc resection and vascular reconstruction to reach wider surgical margins or planned marginal resection with the help of adjuvant therapies should be preferred. This study aimed to determine surgical and oncological outcomes of planned marginal and wide resection of extremity sarcomas that are associated with major vascular structures in the extremities. The collected database of 54 patients treated by the same orthopedic and vascular surgeon for primary or locally recurrent soft and bone tissue sarcoma of extremities was retrospectively reviewed. Eligible subjects for this study were patients diagnosed with upper and lower extremity soft and bone tissue sarcomas that encased a maximum of 50% of the circumference of the major vascular structures, requiring limb-sparing resection. When microscopic positive (19 patients, 33.9%) and negative cases' (35 patients, 66.1%) surgical margins were compared, local recurrence, metastasis, amputation, and tumor type (soft/bone) parameters showed no statistically significant difference. When metastatic and non-metastatic patients were compared, it was shown that bone tumors metastasized more than soft tissue tumors ( = 0.001). However, there was no difference between metastasis and amputation, histopathology, grade, nerve involvement, surgical margins, or local recurrences. The mean survival was 1460.6 ± 137.4 days, and the 6-year mortality was 87.5%. Anesthetic and surgical complication rates may be higher since en bloc resection surgeries of large tumors with vascular reconstructions take a very long time. Therefore, we suggest marginal resection with sub-adventitial dissection in those locations and wide resection at other areas according to the surgeon's experiences about safe margin with the contribution of radiotherapy.
上下肢的骨与软组织肉瘤有时可能与神经血管结构紧密相邻。在这种情况下，对于是应选择整块切除并进行血管重建以获得更宽的手术切缘，还是借助辅助治疗进行计划性边缘切除，仍存在争议。本研究旨在确定对与肢体主要血管结构相关的肢体肉瘤进行计划性边缘切除和广泛切除的手术及肿瘤学结局。回顾性分析了由同一位骨科和血管外科医生治疗的54例原发性或局部复发性肢体软组织和骨组织肉瘤患者的数据库。本研究的合格受试者为被诊断患有上下肢软组织和骨组织肉瘤且最多包绕主要血管结构周长50%、需要保肢切除的患者。比较镜下切缘阳性（19例患者，33.9%）和阴性（35例患者，66.1%）病例时，局部复发、转移、截肢和肿瘤类型（软组织/骨）参数无统计学显著差异。比较转移和未转移患者时，发现骨肿瘤的转移率高于软组织肿瘤（P = 0.001）。然而，转移与截肢、组织病理学、分级、神经受累、手术切缘或局部复发之间无差异。平均生存期为1460.6±137.4天，6年死亡率为87.5%。由于伴有血管重建的大肿瘤整块切除手术耗时很长，麻醉和手术并发症发生率可能更高。因此，我们建议根据外科医生对安全切缘的经验，并在放疗的辅助下，在这些部位进行带外膜下剥离的边缘切除，在其他区域进行广泛切除。
