优化计划外软组织肉瘤切除术的发病率:我们是否应该跳过重建阶梯?

IF 1.4 4区 医学 Q3 SURGERY
Annals of Plastic Surgery Pub Date : 2024-09-01 Epub Date: 2024-06-21 DOI:10.1097/SAP.0000000000004013
Rami Elmorsi, Luis Camacho, David D Krijgh, Gordon S Tilney, Heather Lyu, Raymond S Traweek, Russell G Witt, Margaret S Roubaud, Christina L Roland, Alexander F Mericli
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引用次数: 0

摘要

简介:软组织肉瘤(STS)是一种罕见的多种原发性恶性肿瘤,约占所有恶性肿瘤的 1%。由于这种肿瘤的罕见性,误诊和意外切除 STS 很常见,导致继发性瘤床切除术(TBE)。人们对TBE的重建结果仍然知之甚少,因此本研究旨在填补这一知识空白,并为术前讨论提供参考:这是一项回顾性队列研究,研究对象是在一家四级癌症中心接受 STS 切除术的患者。患者被分为大规模切除术(ME)组和TBE组。重建方法分为简单(初次闭合、复杂修复、植皮、局部皮瓣)和高级(足瓣或游离皮瓣)。比较了各组的术后效果,包括并发症、复发和死亡:结果:在使用简单重建技术时,TBE的总体并发症和主要并发症发生率较高,而ME的总体并发症和轻微并发症发生率较高。组间分析显示,在使用简单重建技术时,TBE 的总体并发症和主要并发症发生率高于 ME,而 ME 的轻微并发症发生率高于 TBE。回归分析显示,与ME简单重建相比,TBE简单重建发生主要并发症和再次手术的几率分别高出90%和180%(P < 0.05):结论:尽管TBE的体积较小,但其对整体和主要并发症的易感性却很高,这对认为在这些病例中只需使用简单技术的观点提出了挑战。我们的研究结果鼓励人们考虑采用先进的重建技术治疗看似适合采用简单重建技术的肺结核。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Optimizing Morbidity in Unplanned Soft Tissue Sarcoma Excisions: Should We Skip the Reconstructive Ladder?

Introduction: Soft tissue sarcomas (STSs) are rare and diverse primary malignant tumors that comprise approximately 1% of all malignancies. Misdiagnoses and unplanned excisions of STSs are common due to the tumor's rarity, leading to secondary tumor bed excisions (TBEs). Reconstructive outcomes for TBEs remain poorly understood, prompting this study to address the knowledge gap and inform preoperative discussions.

Methods: This was a retrospective cohort study of patients who underwent STS excisions at a quaternary cancer center. Patients were categorized into mass excision (ME) and TBE groups. Reconstructive approaches were divided into simple (primary closure, complex repair, skin grafts, local flaps) and advanced (pedicled or free flaps). The groups were compared for postoperative outcomes, including complications, recurrence, and death.

Results: When simple reconstructive techniques were used, TBEs exhibited higher rates of overall and major complications, whereas MEs had higher rates of overall and minor complications. Intergroup analysis revealed that with simple reconstruction, rates of overall and major complications were higher in TBEs than in MEs, and rates of minor complications were higher in MEs than in TBEs. Regression analyses revealed that simple reconstruction of TBEs had 90% and 180% higher odds of major complications and reoperation compared to simple reconstruction of MEs ( P < 0.05).

Conclusion: TBEs, despite their smaller size, exhibited a heightened susceptibility to overall and major complications, challenging the notion that simpler techniques suffice in these cases. Our findings encourage the consideration of advanced reconstructive techniques for TBEs that may seem amenable to simple reconstructive techniques.

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来源期刊
CiteScore
2.70
自引率
13.30%
发文量
584
审稿时长
6 months
期刊介绍: The only independent journal devoted to general plastic and reconstructive surgery, Annals of Plastic Surgery serves as a forum for current scientific and clinical advances in the field and a sounding board for ideas and perspectives on its future. The journal publishes peer-reviewed original articles, brief communications, case reports, and notes in all areas of interest to the practicing plastic surgeon. There are also historical and current reviews, descriptions of surgical technique, and lively editorials and letters to the editor.
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