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成人头颈部肉瘤的治疗:一项回顾性研究。

Management of head & neck sarcomas in adults: A retrospective study.

机构信息

Plastic and Reconstructive Surgery Department, Athens General Anticancer - Oncology Hospital "Aghios Savvas", 171 Alexandras Ave, 11522, Athens, Greece.

出版信息

J Craniomaxillofac Surg. 2024 Aug;52(8):877-883. doi: 10.1016/j.jcms.2024.01.005. Epub 2024 Jan 11.

Abstract

The research purpose is to review the surgical approach and evaluate the results in adult patients with head and neck sarcomas. The histopathology varied, including two leiomyosarcomas, six malignant fibrous histiocytomas, two malignant peripheral nerve sheath tumors, four dermatofibrosarcomas protuberans, three osteosarcomas, two angiosarcomas, one liposarcoma, one Ewing sarcoma, one synovial sarcoma, two unclassified/non-differentiated sarcomas and one solitary fibrous tumor. Surgical resection included maxillectomy, mandibulectomy, craniectomy, parotidectomy, scalp resection, face skin resection and laminectomy. The reconstruction was performed with one rectus abdominis flap, four radial forearm flaps, two latissimus dorsi flaps, two vascularized fibula flaps, two pectoralis major myocutaneous flaps, two trapezius flaps, two temporalis flaps, seven scalp flaps and two nasolabial flaps. The total patient number was 24. The hospitalization was uncomplicated, followed by postoperative radiotherapy in the majority of cases. In a mean 15-year follow-up period, 11 patients are still alive and disease-free. There were four recurrences treated with palliative radiotherapy. The surgical approach for head and neck sarcomas, including the achievement of a functionally acceptable result by organ sparing techniques, remains challenging. Wide resection combined with the appropriate reconstruction, particularly with microsurgical techniques, and followed by adjuvant radiotherapy or chemotherapy offer improved prognosis and quality of life.

摘要

研究目的是回顾手术方法并评估头颈部肉瘤成年患者的治疗结果。组织病理学表现多样,包括 2 例平滑肌肉瘤、6 例恶性纤维组织细胞瘤、2 例恶性外周神经鞘瘤、4 例隆凸性皮肤纤维肉瘤、3 例骨肉瘤、2 例血管肉瘤、1 例脂肪肉瘤、1 例尤文肉瘤、1 例滑膜肉瘤、2 例未分类/未分化肉瘤和 1 例孤立性纤维瘤。手术切除包括上颌骨切除术、下颌骨切除术、颅骨切除术、腮腺切除术、头皮切除术、面颈部皮肤切除术和椎板切除术。重建采用 1 例腹直肌皮瓣、4 例桡侧前臂皮瓣、2 例背阔肌皮瓣、2 例带血管腓骨皮瓣、2 例胸大肌肌皮瓣、2 例斜方肌皮瓣、2 例颞肌皮瓣、7 例头皮皮瓣和 2 例鼻唇沟皮瓣。患者总数为 24 例。住院期间无并发症,随后多数患者接受术后放疗。平均 15 年随访期间,11 例患者无病生存。4 例复发患者行姑息性放疗。头颈部肉瘤的手术方法包括采用保留器官技术实现功能可接受的结果,仍然具有挑战性。广泛切除结合适当的重建,特别是采用显微外科技术,以及术后辅助放疗或化疗可改善预后和生活质量。

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