Goodlad J R, Fletcher C D, Smith M A
St. Thomas' Hospital, London, England.
J Bone Joint Surg Br. 1996 Jul;78(4):658-61.
We reviewed retrospectively 236 consecutive patients seen in our soft-tissue sarcoma clinic. Of these, 95 had had a primary soft-tissue sarcoma excised elsewhere, but with histologically inadequate resection margins. All these patients had a secondary and wider re-excision. The tissues removed at the secondary re-excision were examined histologically for the presence of residual tumour. Definite tumour tissue was found in 29 of 55 lower-limb specimens, 16 of 25 upper-limb, 7 of 10 trunk and 4 of 5 head and neck specimens. In 31 cases some residual tumour was visible macroscopically, and in 56 of the 95 patients (59%) the primary tumour had been incompletely excised. Our results indicated that surgical assessment of the adequacy of excision is very inaccurate and that most local recurrences are the consequence of inadequate primary surgery. The large number of patients who had inadequate initial treatment emphasises the need for a co-ordinated multidisciplinary approach to the management of patients with soft-tissue sarcoma.
我们回顾性分析了在我们软组织肉瘤诊所连续就诊的236例患者。其中，95例曾在其他地方切除过原发性软组织肉瘤，但组织学切缘不充分。所有这些患者均接受了二次更广泛的再次切除。对二次再次切除时切除的组织进行组织学检查，以确定是否存在残留肿瘤。在55例下肢标本中，29例发现明确的肿瘤组织；在上肢的25例中，16例发现；在躯干的10例中，7例发现；在头颈部的5例中，4例发现。31例在宏观上可见一些残留肿瘤，95例患者中有56例（59%）原发性肿瘤切除不完全。我们的结果表明，手术评估切除是否充分非常不准确，大多数局部复发是原发性手术不充分的结果。大量初始治疗不充分的患者强调了对软组织肉瘤患者进行多学科协调管理的必要性。
