Yulian Erwin Danil, Qonita Hana, Kodrat Evelina, Marcevianto Kevin Varian
Division of Surgical Oncology, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Division of Surgical Oncology, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Int J Surg Case Rep. 2022 Jul;96:107345. doi: 10.1016/j.ijscr.2022.107345. Epub 2022 Jun 24.
Function-preserving and Limb-sparing surgery are now the accepted gold standard of care for Extremity Soft Tissue Sarcoma (ESTS) with the goal of surgery for STS of extremities to obtain local tumor control and minimal morbidity. Limb-sparing surgery with post-operative radiotherapy for STS results in high survival rates and local control. Adjuvant radio chemotherapy might improve distant and local recurrence in high-risk patients. Hence, we aim to present how to achieve local tumor control and minimal morbidity for high grade ESTS by conducting limb-sparing surgery combined with appropriate reconstruction and radio chemotherapy.
We present 2 cases with high grade sarcoma that underwent limb-sparing surgery with Latissimus Dorsi (LD) flap reconstructions. Wide excisions were completed with limb-sparing surgeries for both cases with free surgical margins and LD flap reconstructions. There was no post-operative complication. Follow up examination revealed normal function of the arm. The first patient was still in remission after 2-years follow up. The second patient got pulmonary metastasis after complete resection and adjuvant radiotherapy.
Limb-sparing surgery with LD flap reconstruction is able to remove the tumor completely with negative margin for the primary objective. Secondary objectives are minimizing the morbidity, maximizing postoperative body functions, as well as achieving the best cosmetic value are also achieved. LD flap is commonly easy to harvest and able to give large tissue coverage for reconstruction after surgery.
Limb sparing surgery followed by soft-tissue reconstruction and radio chemotherapy are suitable for increasing oncologic outcome, tumor control, and limb preservation. However, inhibitions towards local recurrence and distant metastases were not guaranteed.
功能保留和保肢手术现已成为肢体软组织肉瘤（ESTS）公认的护理金标准，肢体STS手术的目标是实现局部肿瘤控制并将发病率降至最低。肢体STS保肢手术联合术后放疗可带来较高的生存率和局部控制率。辅助放化疗可能改善高危患者的远处和局部复发情况。因此，我们旨在介绍如何通过保肢手术联合适当的重建和放化疗来实现高级别ESTS的局部肿瘤控制并将发病率降至最低。
我们呈现2例高级别肉瘤患者，他们接受了背阔肌（LD）皮瓣重建的保肢手术。两例患者均进行了保肢手术，广泛切除肿瘤，切缘阴性，并进行了LD皮瓣重建。术后无并发症。随访检查显示手臂功能正常。首例患者随访2年后仍处于缓解期。第二例患者在完全切除并接受辅助放疗后发生了肺转移。
采用LD皮瓣重建的保肢手术能够以切缘阴性为首要目标完全切除肿瘤。次要目标包括将发病率降至最低、最大化术后身体功能以及实现最佳的美容效果。LD皮瓣通常易于切取，术后能够提供大面积组织覆盖用于重建。
保肢手术联合软组织重建和放化疗适用于提高肿瘤学疗效、控制肿瘤以及保留肢体。然而，无法保证抑制局部复发和远处转移。
