Impact of Surgical Margin in Skull Base Surgery for Head and Neck Sarcomas
Impact of Surgical Margin in Skull Base Surgery for Head and Neck Sarcomas
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DOI：
10.1055/s-0037-1615816
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发表时间：
2018-10-01
影响因子：
0.9
通讯作者：
Yoshimoto, Seiichi
中科院分区：
文献类型：
--
作者：
Kobayashi, Kenya;Matsumoto, Fumihiko;Yoshimoto, Seiichi
目的探讨头颈部肉瘤颅底手术的适宜切除范围。设计：回顾分析22例侵犯颅底的肉瘤。对18例化疗敏感的肉瘤患者行诱导化疗，术后放疗和辅助化疗；对4例化疗耐药肉瘤患者行手术加或不加放疗。对于对诱导化疗反应差的化疗敏感肉瘤患者和化疗耐药肉瘤患者进行根治性切除。对化疗敏感的肉瘤患者行手术切缘封闭的保守性切除。背景和参与者这项单中心的回顾性研究包括来自日本国立肿瘤中心医院的患者。结果诱导化疗的有效率与3年局部控制率显著相关(LCR值：好与差：100%比63%，P=0.048)。化疗反应良好的患者，即使局部治疗是保守切除，也有良好的局部预后。在根治性颅底手术中，手术切缘为“宽切缘阳性”的患者3年长期生存率显著低于切缘“切缘阴性”或“切缘微切缘阳性”的患者(25%比83%，P=0.014)。结论对于化疗反应良好的化疗敏感性肉瘤，保守切除切缘较近的手术切缘是可以接受的。手术切缘状况是颅底根治术后局部复发的重要预测因素。微小残留肿瘤可通过术后治疗得到控制。
Objective This study aimed to determine the adequate resection margin in skull base surgery for head and neck sarcoma.Design We retrospectively reviewed 22 sarcomas with skull base invasion. Induction chemotherapy, followed by surgery and postoperative radiotherapy and adjuvant chemotherapy, was performed in 18 patients with chemosensitive sarcomas, and surgery with or without postoperative radiotherapy was performed in four patients with chemoresistant sarcomas. Radical resection was performed in patients with chemosensitive sarcomas with a poor response to induction chemotherapy and in patients with chemoresistant sarcomas. Conservative resection with close surgical margin was performed in patients with chemosensitive sarcomas with a good response to induction chemotherapy.Setting and Participants This single-centered retrospective study included patients from the National Cancer Center Hospital, Japan.Results The response to induction chemotherapy was significantly associated with the 3-year local control rate (LCR; good response versus poor response: 100% versus 63%, p = 0.048). Patients with a good response to chemotherapy had a favorable local prognosis even when the local therapy was conservative resection. In radical skull base surgery, patients whose surgical margins were classified as "wide margin positive" had significantly poorer 3-year LCR than did patients with "margin negative" or "micro margin positive" margins (25% versus 83%, p = 0.014).Conclusion Conservative resection with close surgical margins might be acceptable for chemosensitive sarcomas with a good response to chemotherapy. Resection margin status was an important predictive factor for local recurrence after radical skull base surgery. Microscopic microresidual tumor might be controlled by postoperative treatment.