{"title":"上肢远端肉瘤计划切除与非计划切除的早期并发症","authors":"","doi":"10.1016/j.jhsg.2024.04.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>Unplanned excisions are defined as excisions of malignant tumors performed without preoperative cross-sectional imaging or diagnostic biopsy, frequently resulting in residual disease and re-excision secondary to positive surgical margins. The purpose of this study was to compare the relative morbidity of planned versus unplanned upper-extremity sarcoma excisions.</p></div><div><h3>Methods</h3><p>A single tertiary referral hospital pathology database was queried from January 2015 through 2022 for primary upper-extremity sarcomas (forearm, wrist, hand, and finger). Demographics, tumor features, survival characteristics, and outcomes were retrospectively reviewed.</p></div><div><h3>Results</h3><p>Forty-two upper-extremity sarcoma patients were identified, two-thirds of whom had unplanned excisions. Those with unplanned excisions were more likely to be female (relative risk [RR]: 1.9; <em>P</em> = .002), undergo initial excision at a nonsarcoma center (RR: 14.0; <em>P</em> < .001), have masses distal to the forearm (RR: 1.6; <em>P</em> = .02), and have smaller masses (4.8 vs 7.4 cm, <em>P</em> = .03). 71.4% of tumors were high grade, and 60.7% less than 5 cm in size.</p><p>Unplanned excisions had positive margins in 96.4% of cases and were more likely to undergo re-excision (odds ratio [OR]: 20.0; <em>P</em> = .001), more total resections (2.7 vs 1.4, <em>P</em> = .009), sacrifice of neurovascular structures (OR: 6.1; <em>P</em> = .04), adjuvant radiation therapy (OR: 4.5; <em>P</em> = .05), adjuvant systemic therapy (OR: 10.9; <em>P</em> = .03), or experience a complication (OR: 17.6; <em>P</em> = .002) at an average of 38.0 months of follow-up.</p><p>Nearly half of all unplanned excision patients developed a local recurrence or metastatic disease. Six patients required an amputation versus one in the planned cohort (<em>P</em> = .17), and 26.5% of patients died at an average of 32.5 months from presentation.</p></div><div><h3>Conclusions</h3><p>Distal upper-extremity sarcoma excisions are frequently unplanned, with high rates of morbidity compared with planned excisions. Surgeons should have a low threshold for cross-sectional imaging and core needle biopsy of atypical lesions, irrespective of size, with referral to a sarcoma center.</p></div><div><h3>Type of study/level of evidence</h3><p>Prognostic IV.</p></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 4","pages":"Pages 558-562"},"PeriodicalIF":0.0000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589514124000859/pdfft?md5=076996f538a28d3efc8c63df3187cba4&pid=1-s2.0-S2589514124000859-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Early Complications of Planned Resection Versus Unplanned Excision of Sarcomas in the Distal Upper Extremity\",\"authors\":\"\",\"doi\":\"10.1016/j.jhsg.2024.04.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>Unplanned excisions are defined as excisions of malignant tumors performed without preoperative cross-sectional imaging or diagnostic biopsy, frequently resulting in residual disease and re-excision secondary to positive surgical margins. The purpose of this study was to compare the relative morbidity of planned versus unplanned upper-extremity sarcoma excisions.</p></div><div><h3>Methods</h3><p>A single tertiary referral hospital pathology database was queried from January 2015 through 2022 for primary upper-extremity sarcomas (forearm, wrist, hand, and finger). Demographics, tumor features, survival characteristics, and outcomes were retrospectively reviewed.</p></div><div><h3>Results</h3><p>Forty-two upper-extremity sarcoma patients were identified, two-thirds of whom had unplanned excisions. Those with unplanned excisions were more likely to be female (relative risk [RR]: 1.9; <em>P</em> = .002), undergo initial excision at a nonsarcoma center (RR: 14.0; <em>P</em> < .001), have masses distal to the forearm (RR: 1.6; <em>P</em> = .02), and have smaller masses (4.8 vs 7.4 cm, <em>P</em> = .03). 71.4% of tumors were high grade, and 60.7% less than 5 cm in size.</p><p>Unplanned excisions had positive margins in 96.4% of cases and were more likely to undergo re-excision (odds ratio [OR]: 20.0; <em>P</em> = .001), more total resections (2.7 vs 1.4, <em>P</em> = .009), sacrifice of neurovascular structures (OR: 6.1; <em>P</em> = .04), adjuvant radiation therapy (OR: 4.5; <em>P</em> = .05), adjuvant systemic therapy (OR: 10.9; <em>P</em> = .03), or experience a complication (OR: 17.6; <em>P</em> = .002) at an average of 38.0 months of follow-up.</p><p>Nearly half of all unplanned excision patients developed a local recurrence or metastatic disease. Six patients required an amputation versus one in the planned cohort (<em>P</em> = .17), and 26.5% of patients died at an average of 32.5 months from presentation.</p></div><div><h3>Conclusions</h3><p>Distal upper-extremity sarcoma excisions are frequently unplanned, with high rates of morbidity compared with planned excisions. Surgeons should have a low threshold for cross-sectional imaging and core needle biopsy of atypical lesions, irrespective of size, with referral to a sarcoma center.</p></div><div><h3>Type of study/level of evidence</h3><p>Prognostic IV.</p></div>\",\"PeriodicalId\":36920,\"journal\":{\"name\":\"Journal of Hand Surgery Global Online\",\"volume\":\"6 4\",\"pages\":\"Pages 558-562\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2589514124000859/pdfft?md5=076996f538a28d3efc8c63df3187cba4&pid=1-s2.0-S2589514124000859-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hand Surgery Global Online\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589514124000859\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery Global Online","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589514124000859","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的计划外切除是指术前未进行横断面影像学检查或诊断性活检而进行的恶性肿瘤切除术，经常导致残留疾病和继发于手术边缘阳性的再次切除。本研究的目的是比较计划内与计划外上肢肉瘤切除术的相对发病率。研究方法查询了一家三级转诊医院的病理数据库，该数据库从2015年1月到2022年一直用于原发性上肢肉瘤（前臂、手腕、手和手指）的病例。结果共发现42例上肢肉瘤患者，其中三分之二的患者接受了计划外切除术。非计划性切除的患者更可能是女性（相对风险[RR]：1.9；P = .002），在非肉瘤中心进行初次切除（RR：14.0；P <.001），肿块位于前臂远端（RR：1.6；P = .02），肿块较小（4.8 vs 7.4 cm，P = .03）。71.4%的肿瘤为高级别，60.7%的肿瘤小于5厘米。96.4%的非计划切除病例边缘阳性，更有可能接受再次切除（比值比 [OR]：20.0；P = .001）、更多的全切除（2.7 vs 1.4，P = .009）、牺牲神经血管结构（OR：6.在平均 38.0 个月的随访中，近一半的计划外切除患者出现了局部复发或转移性疾病。结论远端上肢肉瘤切除术经常是非计划性的，与计划性切除术相比，其发病率较高。外科医生对不典型病变的横断面成像和核心穿刺活检应该有较低的门槛，无论病变大小，都应转诊至肉瘤中心。
Early Complications of Planned Resection Versus Unplanned Excision of Sarcomas in the Distal Upper Extremity
Purpose
Unplanned excisions are defined as excisions of malignant tumors performed without preoperative cross-sectional imaging or diagnostic biopsy, frequently resulting in residual disease and re-excision secondary to positive surgical margins. The purpose of this study was to compare the relative morbidity of planned versus unplanned upper-extremity sarcoma excisions.
Methods
A single tertiary referral hospital pathology database was queried from January 2015 through 2022 for primary upper-extremity sarcomas (forearm, wrist, hand, and finger). Demographics, tumor features, survival characteristics, and outcomes were retrospectively reviewed.
Results
Forty-two upper-extremity sarcoma patients were identified, two-thirds of whom had unplanned excisions. Those with unplanned excisions were more likely to be female (relative risk [RR]: 1.9; P = .002), undergo initial excision at a nonsarcoma center (RR: 14.0; P < .001), have masses distal to the forearm (RR: 1.6; P = .02), and have smaller masses (4.8 vs 7.4 cm, P = .03). 71.4% of tumors were high grade, and 60.7% less than 5 cm in size.
Unplanned excisions had positive margins in 96.4% of cases and were more likely to undergo re-excision (odds ratio [OR]: 20.0; P = .001), more total resections (2.7 vs 1.4, P = .009), sacrifice of neurovascular structures (OR: 6.1; P = .04), adjuvant radiation therapy (OR: 4.5; P = .05), adjuvant systemic therapy (OR: 10.9; P = .03), or experience a complication (OR: 17.6; P = .002) at an average of 38.0 months of follow-up.
Nearly half of all unplanned excision patients developed a local recurrence or metastatic disease. Six patients required an amputation versus one in the planned cohort (P = .17), and 26.5% of patients died at an average of 32.5 months from presentation.
Conclusions
Distal upper-extremity sarcoma excisions are frequently unplanned, with high rates of morbidity compared with planned excisions. Surgeons should have a low threshold for cross-sectional imaging and core needle biopsy of atypical lesions, irrespective of size, with referral to a sarcoma center.
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