Stöckle E, Rivoire M
Institut Bergonié, Centre Régional de Lutte Contre le Cancer, Bordeaux.
Ann Chir. 1996;50(3):263-75.
The place of surgery in the treatment of soft-tissue sarcoma is defined in the light of a review of the recent litterature. Usual treatment combines conservative surgery and radiotherapy. The essential risk factor of local recurrence is the quality of surgical resection, defined by the definitive resection margins. The addition of radiotherapy after inadequate surgery can improve local control, but cannot ensure that obtained after adequate surgery. Some limited tumours can be treated by surgery alone, but radiotherapy remains essential in more advanced tumours. Under these conditions, local recurrence rates after surgery alone, surgery and systematic radiotherapy and surgery with radiotherapy, as required are 27%, 28% and 30% respectively. The development of a local recurrence appears to affect survival in tumour with a good initial prognosis, early recurrence determining unfavourable outcome. Serious postoperative morbidity is observed in 14% of the cases and is responsible for delayed treatment and functional disorders. The use of muscle flaps to fill the surgical defects can reduce these complications. Evaluation of the functional results must be based on predefined objective criteria.
根据近期文献综述确定了手术在软组织肉瘤治疗中的地位。常规治疗包括保守手术和放疗。局部复发的主要危险因素是手术切除的质量，由切缘是否彻底来界定。手术不充分后加用放疗可改善局部控制，但无法确保达到充分手术后的效果。一些局限性肿瘤可单独通过手术治疗，但放疗对更晚期肿瘤仍然至关重要。在这些情况下，单纯手术、手术加系统性放疗以及必要时手术加放疗后的局部复发率分别为27%、28%和30%。局部复发的出现似乎会影响初始预后良好的肿瘤的生存率，早期复发决定不良结局。14%的病例观察到严重的术后并发症，这导致治疗延迟和功能障碍。使用肌皮瓣填充手术缺损可减少这些并发症。功能结果的评估必须基于预先确定的客观标准。
