Sugarbaker T A, Chang D, Koslowe P, Sugarbaker P H
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Cancer Treat Res. 1996;82:65-77. doi: 10.1007/978-1-4613-1247-5_5.
A prominent site for recurrence of retroperitoneal and visceral sarcoma is the abdominal cavity. In an attempt to understand the causation of local and regional recurrence, 21 sarcoma patients who had previously undergone "complete" surgical removal of the primary tumor were prospectively studied. Data were obtained retrospectively from the first operation and prospectively from the reoperative procedure at the Washington Cancer Institute. At the primary and reoperative surgeries, 9 abdominopelvic regions and 21 sites were scored and then cataloged in a standardized fashion. Tumor locations and surgical resections were statistically analyzed in an attempt to establish patterns of recurrence within the abdomen and pelvis. There was a significant difference in sites of recurrence when sarcomas that involved the parietal structures were compared with those that involved small bowel. Peritoneal implants (nodular recurrences) were uniformly present in both groups. In contrast, resection site recurrences were very common with primary sarcomas invested by parietal peritoneum, while they were absent in those covered by visceral peritoneum. When primary surgeries were compared with reoperations, there was an increasing intraabdominal dissemination; the mean number of regions increased from 1.81 to 5.13. The change in distribution of sarcoma deposits at reoperation was greatest in right upper (because of liver surface) central and pelvic abdominopelvic regions and lowest in the left upper and epigastrium. The four anatomic sites that revealed a significant increase in involvement at the time of recurrence were the greater omentum, liver surface, large bowel, and the cul-de-sac of Douglas (all p < 0.002). Regions with tumor involvement or regions subjected to surgical trauma at the time of primary sarcoma resection were significantly more likely to show sarcoma deposits than to be sarcoma free at reoperation. These data taken together may suggest that sarcoma tumor emboli are frequently present in the abdomen at the time of resection of the primary cancer and that these tumor emboli are entrapped in fibrinous material at or immediately adjacent to sites of surgical trauma and along narrow margins of resection. Tumor cell entrapment of sarcoma emboli released into the peritoneal cavity prior to or at the time of sarcoma resection may help explain the distribution of nodular and fusiform recurrence of abdominopelvic sarcoma.
腹膜后和内脏肉瘤复发的一个显著部位是腹腔。为了了解局部和区域复发的原因，对21例先前已“完整”手术切除原发性肿瘤的肉瘤患者进行了前瞻性研究。数据回顾性地取自首次手术，前瞻性地取自华盛顿癌症研究所的再次手术。在初次手术和再次手术时，对9个腹盆腔区域和21个部位进行评分，然后以标准化方式进行分类。对肿瘤位置和手术切除情况进行统计学分析，以试图确定腹部和盆腔内的复发模式。当比较累及壁层结构的肉瘤与累及小肠的肉瘤时，复发部位存在显著差异。两组均有腹膜种植（结节状复发）。相比之下，原发性肉瘤被壁层腹膜覆盖时，切除部位复发非常常见，而在内脏腹膜覆盖的肉瘤中则不存在。当比较初次手术和再次手术时，腹腔内播散有所增加；区域的平均数量从1.81增加到5.13。再次手术时肉瘤沉积物分布变化在右上腹（由于肝表面）、中腹和盆腔腹盆腔区域最大，在左上腹和上腹部最低时。复发时受累显著增加的四个解剖部位是大网膜、肝表面、大肠和Douglas陷凹（所有p<0.002）。原发性肉瘤切除时受累肿瘤的区域或遭受手术创伤的区域在再次手术时出现肉瘤沉积物的可能性明显高于无肉瘤情况。综合这些数据可能表明，在原发性癌症切除时，腹部经常存在肉瘤肿瘤栓子，并且这些肿瘤栓子被困在手术创伤部位或紧邻手术创伤部位以及切除边缘狭窄处的纤维蛋白物质中。在肉瘤切除前或切除时释放到腹腔内的肉瘤栓子的肿瘤细胞截留可能有助于解释腹盆腔肉瘤结节状和梭形复发的分布情况。
