Thomas Benjamin, Bigdeli Amir K, Nolte Steffen, Gazyakan Emre, Harhaus Leila, Bischel Oliver, Lehner Burkhard, Egerer Gerlinde, Mechtersheimer Gunhild, Hohenberger Peter, Horch Raymund E, Andreou Dimosthenis, Schmitt Jochen, Schuler Markus K, Eichler Martin, Kneser Ulrich
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany.
Department of Otorhinolaryngology, Head and Neck Surgery, Armed Forces Hospital Ulm, 89081 Ulm, Germany.
Cancers (Basel). 2022 Sep 2;14(17):4312. doi: 10.3390/cancers14174312.
Although the involvement of plastic surgery has been deemed important in the treatment of sarcoma patients to avoid oncological compromises and ameliorate patient outcomes, it is not ubiquitously available. The accessibility of defect reconstruction and its therapeutic impact on sarcoma care is the subject of this analysis. Cross-sectional data from 1309 sarcoma patients were collected electronically at 39 German study centers from 2017 to 2019. A total of 621 patients with surgical treatment for non-visceral soft-tissue sarcomas were included. The associated factors were analyzed exploratively using multifactorial logistic regression to identify independent predictors of successful defect reconstruction, as well Chi-squared and Cochran-Mantel-Haenszel tests to evaluate subgroups, including limb-salvage rates in extremity cases. A total of 76 patients received reconstructive surgery, including 52 local/pedicled versus 24 free flaps. Sarcomas with positive margins upon first resection (OR = 2.3, 95%CI = 1.2-4.4) that were excised at centers with lower degrees of specialization (OR = 2.2, 95%CI = 1.2-4.2) were independently associated with the need for post-oncological defect coverage. In this context, the inhouse availability of plastic surgery (OR = 3.0, 95%CI = 1.6-5.5) was the strongest independent predictor for successful flap-based reconstruction, which in turn was associated with significantly higher limb-salvage rates (OR = 1.4, 95%CI = 1.0-2.1) in cases of extremity sarcomas ( = 366, 59%). In conclusion, consistent referral to specialized interdisciplinary sarcoma centers significantly ameliorates patient outcomes by achieving higher rates of complete resections and offering unrestricted access to plastic surgery. The latter in particular proved indispensable for limb salvage through flap-based defect reconstruction after sarcoma resection. In fact, although there remains a scarcity of readily available reconstructive surgery services within the current sarcoma treatment system in Germany, plastic and reconstructive flap transfer was associated with significantly increased limb-salvage rates in our cohort.
尽管整形外科在肉瘤患者的治疗中被认为对避免肿瘤治疗的妥协和改善患者预后很重要，但并非随处可得。缺损重建的可及性及其对肉瘤治疗的影响是本分析的主题。2017年至2019年期间，在德国39个研究中心以电子方式收集了1309例肉瘤患者的横断面数据。总共纳入了621例接受非内脏软组织肉瘤手术治疗的患者。使用多因素逻辑回归探索性分析相关因素，以确定成功进行缺损重建的独立预测因素，并使用卡方检验和 Cochr an-Mantel-Haenszel检验评估亚组，包括肢体肉瘤病例的保肢率。共有76例患者接受了重建手术，其中52例采用局部/带蒂皮瓣，24例采用游离皮瓣。首次切除切缘阳性的肉瘤（OR = 2.3，95%CI = 1.2 - 4.4）以及在专业化程度较低的中心切除的肉瘤（OR = 2.2，95%CI = 1.2 - 4.2）与肿瘤切除后缺损覆盖的需求独立相关。在这种情况下，整形外科的内部可及性（OR = 3.0，95%CI = 1.6 - 5.5）是基于皮瓣的成功重建的最强独立预测因素，而这反过来又与肢体肉瘤病例（n = 366，59%）显著更高的保肢率（OR = 1.4，95%CI = 1.0 - 2.1）相关。总之，持续转诊至专业的跨学科肉瘤中心，通过实现更高的完整切除率和提供不受限制的整形外科服务，显著改善了患者预后。后者对于肉瘤切除后通过基于皮瓣的缺损重建进行保肢尤其不可或缺。事实上，尽管德国目前的肉瘤治疗系统中现成的重建手术服务仍然稀缺，但在我们的队列中，整形和重建皮瓣转移与显著提高的保肢率相关。
