Aitken D R, James A G, Carey L C
Arch Surg. 1984 Jun;119(6):643-6. doi: 10.1001/archsurg.1984.01390180011002.
We examined the risk factors for the development of local recurrence in patients treated with a conservative wide local excision, which was defined as being less than the historical 5-cm margin. There were 118 patients with clinical stage I disease followed up for a minimum of 60 months or until death. The extent of wide local excision varied from 0.6 to 8.5 cm. The majority (76.3%) had a resection margin of 30 mm or less. Four patients (3.4%) had local recurrence within 5 cm of the primary closure scar or skin graft edge. The primary lesion in the patients with local recurrence had deeper invasion and larger diameters than the lesion in patients who did not have local recurrence. Other recognized risk factors, such as ulceration, satellitosis , and unrecognized subclinical stage II disease, at the time of initial diagnosis were noted in the patients eventually displaying local recurrence. Tumor aggressiveness was recognized. The patients who had local recurrence had excisions with wider margins (mean, 4.75 cm; range, 2.5 to 8.5 cm) than the patients without local recurrence (mean, 2.87 cm; range, 0.6 to 6.0 cm). A tumor-field effect did not contribute to local recurrence.
我们研究了接受保守性局部广泛切除（定义为切除边缘小于既往的5厘米切缘）治疗的患者发生局部复发的危险因素。共有118例临床I期疾病患者，随访时间至少60个月或直至死亡。局部广泛切除的范围为0.6至8.5厘米。大多数（76.3%）患者的切除边缘为30毫米或更小。4例（3.4%）患者在原闭合切口瘢痕或皮肤移植边缘5厘米范围内发生局部复发。发生局部复发的患者的原发病变比未发生局部复发的患者的病变浸润更深、直径更大。在最终出现局部复发的患者中，还发现了其他公认的危险因素，如初次诊断时的溃疡、卫星灶以及未识别的亚临床II期疾病。肿瘤侵袭性得到确认。发生局部复发的患者的切除边缘（平均4.75厘米；范围2.5至8.5厘米）比未发生局部复发的患者（平均2.87厘米；范围0.6至6.0厘米）更宽。肿瘤野效应与局部复发无关。
