Surgical outcomes of bone sarcoma of the foot
Surgical outcomes of bone sarcoma of the foot
复制标题
足部骨肉瘤的手术效果
DOI：
10.1093/jjco/hyab118
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Abudu A.
中科院分区：
文献类型：
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作者：
Tsuda Y;Fujiwara T;Stevenson JD;Abudu A.
目的足部骨肉瘤解剖结构复杂，邻近神经血管结构，持久的重建选择较少，因此保肢具有挑战性。方法我们回顾性分析了50例接受手术的足部原发性恶性骨肉瘤患者，包括软骨肉瘤（n=23）、尤文氏肉瘤（n=14）和骨肉瘤（n=13）。结果中位随访时间为68 个月。主要部位是跖骨 (n=18)、指骨 (n=15)、跟骨 (n=13) 和其他部位 (n=4)。软骨肉瘤、尤文氏肉瘤和骨肉瘤的 5 年疾病特异性生存率分别为 100%、83% 和 83%。分别有 21 名、24 名、2 名和 3 名患者进行了膝下截肢、射线/脚趾截肢、切除和刮除术。 94% 的中足/后足肿瘤接受了膝盖以下截肢手术。 42 例、5 例和 3 例患者的手术切缘为宽/根治性切缘、边缘切缘和病灶内切缘。三名患者 (6%) 出现局部复发，而在切缘较宽/根治性患者中未观察到局部复发。 3 名患者出现术后并发症（6%；手术部位感染 n = 2 例，伤口延迟愈合 n = 1 例）。平均 MSTS 功能评分为 26 分（范围为 19-30）。结论 实现了良好的局部控制，功能结果和术后并发症可接受；几乎所有中足/后足肿瘤都需要膝关节以下截肢，以实现宽/根治性边缘且无局部复发。
ObjectiveLimb-salvage following resection of bone sarcomas of the foot are challenging due to the complicated anatomy, adjacent neurovascular structures and few durable reconstruction options.MethodsWe retrospectively analysed 50 patients with primary malignant bone sarcoma of the foot who underwent surgery including chondrosarcoma (n= 23), Ewing’s sarcoma (n= 14) and osteosarcoma (n= 13).ResultsMedian follow-up was 68 months. The primary sites were metatarsal (n= 18), phalanges (n= 15), calcaneus (n= 13) and others (n= 4). The 5-year disease-specific survivals were 100, 83 and 83% in chondrosarcoma, Ewing’s sarcoma and osteosarcoma, respectively. Below knee amputation, ray/toe amputation, excision and curettage were performed in 21, 24, 2 and 3 patients, respectively. Below knee amputation was performed in 94% of mid/hindfoot tumours. Surgical margins were wide/radical, marginal and intralesional margin in 42, 5 and 3 patients. Three patients (6%) developed local recurrence, whereas, local recurrence was not observed in patients with wide/radical margins. Postoperative complications occurred in 3 patients (6%; surgical site infectionn= 2 and delayed wound healingn= 1). Mean MSTS functional score was 26 points (range, 19–30).ConclusionsGood local control was achieved with acceptable functional outcomes and post-operative complications; almost all mid/hindfoot tumours required below knee amputation achieving wide/radical margins without local recurrence.