Fang Xiang, Xiong Yan, Yuan Fang, Lei Senlin, Yuan Dechao, Luo Yi, Zhou Yong, Min Li, Zhang Wenli, Tu Chongqi, Duan Hong
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.
Cancers (Basel). 2022 Jun 29;14(13):3185. doi: 10.3390/cancers14133185.
Axillary soft tissue sarcoma (STS) is challenging due to its proximity to vital neurovascular bundles. We conducted a prospective observational pilot study to explore whether 3D multimodality imaging (3DMMI) can improve preoperative planning for and surgical outcomes of patients with axillary STS. Twenty-one patients with STS (diameter > 5 cm) of the axilla were allocated, at their discretion, to either a control group undergoing traditional preoperative planning with separate computed tomography angiography, magnetic resonance imaging, and magnetic resonance neurography, or an intervention group where 3DMMI, digitally created based on these images, revealed the tumour and adjacent skeletomuscular and neurovascular structures in three dimensions. Primary outcome measures were surgical margins and surgical complications. Secondary outcomes included operative time, blood loss, serum C-reactive protein and interleukin-6, length of hospital stay, and limb function. The 3DMMI group had a lower, although not significantly different, inadvertent positive margin rate (1/12 vs. 3/9, p = 0.272), a significantly shorter operative time (p = 0.048), reduced blood loss (p = 0.038), and reduced length of hospital stay (p = 0.046). This endorses larger trials to improve complex surgical procedures and study how preoperative planning could be performed in the future.
腋窝软组织肉瘤（STS）因其靠近重要神经血管束而具有挑战性。我们进行了一项前瞻性观察性试点研究，以探讨三维多模态成像（3DMMI）是否能改善腋窝STS患者的术前规划和手术效果。21例腋窝STS（直径>5 cm）患者可自行选择分配到对照组或干预组，对照组采用传统的术前规划，分别进行计算机断层血管造影、磁共振成像和磁共振神经造影，干预组则基于这些图像进行数字创建的3DMMI，以三维方式显示肿瘤及相邻的骨骼肌肉和神经血管结构。主要结局指标为手术切缘和手术并发症。次要结局包括手术时间、失血量、血清C反应蛋白和白细胞介素-6、住院时间和肢体功能。3DMMI组的意外阳性切缘率较低（1/12 vs. 3/9，p = 0.272），虽无显著差异，但手术时间显著缩短（p = 0.048），失血量减少（p = 0.038），住院时间缩短（p = 0.046）。这支持进行更大规模的试验，以改进复杂的外科手术，并研究未来如何进行术前规划。
