From the Departments of Plastic Surgery.
Orthopaedic Oncology, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2023 Jul 1;152(1):194-205. doi: 10.1097/PRS.0000000000010182. Epub 2023 Jun 29.
Forequarter amputations (FQAs) and extended forequarter amputations (EFQAs) are rare procedures with high morbidity that often require significant soft-tissue or bony reconstruction. The authors describe the largest series of oncologic FQAs and EFQAs to date with associated reconstructive and oncologic outcomes.
The authors retrospectively reviewed data from all patients who underwent FQA or EFQA at The University of Texas M. D. Anderson Cancer Center from January 1, 2008, to January 1, 2019. Surgical outcomes, survival, and local recurrence rates were summarized and compared.
Forty-seven patients met the inclusion criteria, including 14 with EFQAs. Most patients (53%) were male; the median age was 58 years (range, 2 to 74). The most common tumor type was sarcoma (79%), and the most common presentation was recurrent (34%). Nineteen patients (40%) had distant metastases. The median defect size was 351 cm 2 ; flap reconstruction was required in 30 patients (64%). Eight patients (17%) experienced immediate complications and 12 (26%) experienced delayed complications. The median overall survival (OS) time was 21 months and the 5-year OS rate was 28.1%. OS and disease-free survival were superior in the EFQA group (69.8% versus 11.6%, P = 0.017; 58.9% versus 9.8%, P = 0.014, respectively). Metastasis at presentation was the most important predictor of survival on multivariate analysis (OR, 3.98; P = 0.004).
Patients with EFQA had better OS and disease-free survival than did patients with FQA, owing to a lower incidence of metastatic disease. This study suggests a benefit to more aggressive resection and reconstruction when disease is locally confined.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
前肩部截肢术（FQAs）和扩展前肩部截肢术（EFQAs）是罕见的高发病率手术，通常需要进行大量的软组织或骨重建。作者描述了迄今为止最大系列的肿瘤 FQAs 和 EFQAs，以及相关的重建和肿瘤学结果。
作者回顾性分析了 2008 年 1 月 1 日至 2019 年 1 月 1 日期间在德克萨斯大学 MD 安德森癌症中心接受 FQA 或 EFQA 的所有患者的数据。总结并比较了手术结果、生存率和局部复发率。
47 名患者符合纳入标准，其中 14 名患者接受了 EFQA。大多数患者（53%）为男性；中位年龄为 58 岁（范围 2 至 74 岁）。最常见的肿瘤类型是肉瘤（79%），最常见的表现是复发（34%）。19 名患者（40%）有远处转移。中位缺损面积为 351cm²；30 名患者（64%）需要进行皮瓣重建。8 名患者（17%）发生了即时并发症，12 名患者（26%）发生了延迟并发症。中位总生存（OS）时间为 21 个月，5 年 OS 率为 28.1%。EFQA 组的 OS 和无病生存率均优于 FQA 组（69.8%对 11.6%，P=0.017；58.9%对 9.8%，P=0.014）。多因素分析显示，就诊时转移是生存的最重要预测因素（OR，3.98；P=0.004）。
由于转移性疾病的发生率较低，EFQA 患者的 OS 和无病生存率均优于 FQA 患者。这项研究表明，在疾病局限于局部时，更积极的切除和重建可能有益。
临床问题/证据水平：治疗性，III 级。
