Chest wall desmoid tumors: Results of surgical intervention
Chest wall desmoid tumors: Results of surgical intervention
复制标题
DOI：
10.1016/j.athoracsur.2004.03.015
复制
发表时间：
2004-10-01
影响因子：
4.6
通讯作者：
Pairolero, PC
中科院分区：
文献类型：
--
作者：
Abbas, AE;Deschamps, C;Pairolero, PC
背景我们正在分析我们的经验，治疗硬纤维瘤的胸壁和邻近结构。回顾性分析了1980年1月至2001年12月在一家机构接受胸部硬纤维瘤手术治疗的所有患者的记录。共纳入53例患者（男24例，女29例），中位年龄39岁（10 ~ 78岁）。硬纤维瘤仅累及胸壁者25例（47%），累及胸壁及邻近结构者28例（53%）。28名患者（53%）曾因硬纤维瘤切除。3例患者既往接受过放射治疗。在所有53例患者中尝试了广泛的根治性切除术; 44例完成了切除。7例患者显微镜下切缘阳性，2例有大体残留病变。6例患者（11%）出现并发症;无手术死亡。中位住院时间为6天（范围1 - 124天）。19例患者（36%）接受了术后放疗（12例完全切除，7例切缘阳性）。51例患者（96%）完成随访，随访时间范围为2周至21年（中位时间为53个月）。在审查结束时，46例患者存活且无复发; 3例存活但局部复发，2例死亡（1例死于转移性乳腺癌，1例死于不明原因）。5年局部复发的总体概率为37.5%（95%置信区间，20.2%至53.3%）。9例切缘阳性患者中有8例复发（89%），44例切缘阴性患者中有8例复发（18%）。影响术后复发率的不利因素是再次手术（p = 0.0199）、切缘阳性（p < 0.0001）和术后放疗（p = 0.0027）。11例患者（22%）在术后中位24.6个月（范围11至78个月）时需要再次手术。硬纤维瘤累及胸部和邻近结构，是一种局部侵袭性肿瘤，复发率高。应尽可能尝试广泛根治性切除。切除、再手术和术后放疗时切缘阳性与局部复发风险高相关。(C)2004年由胸外科医师协会发布。
Background. We are analyzing our experience with treatment of desmoid tumors of the chest wall and adjacent structures.Methods. A retrospective review was undertaken of the records of all patients who underwent surgical management for a desmoid tumor of the chest between January 1980 and December 2001 at one institution. Fifty-three patients (24 men and 29 women) were identified, whose median age was 39 years (range 10 to 78 years).Results. The desmoid tumor involved the chest wall exclusively in 25 patients (47%) and both the chest wall and adjacent structures in 28 (53%). Twenty-eight patients (53%) had previous resections for a desmoid tumor. Three patients also had previous radiation therapy. A wide radical resection was attempted in all 53 patients; resection was complete in 44. Seven patients had positive microscopic margins and 2 had gross residual disease. Complications were noted in 6 patients (11%); no operative deaths occurred. Median hospitalization was 6 days (range 1 to 124 days). Nineteen patients (36%) had postoperative radiation therapy (12 had complete resection and 7 had positive margins). Follow-up was complete in 51 patients (96%) and ranged from 2 weeks to 21 years (median 53 months). At the end of the review 46 patients were alive with no recurrence; 3 were alive with local recurrence and 2 died (1 from metastatic breast cancer and 1 from unknown cause). Five-year overall probability of developing a local recurrence was 37.5% (95% confidence interval, 20.2% to 53.3%). Recurrence occurred in 8 of 9 patients with positive margins (89%) and 8 of 44 with negative margins (18%). Factors adversely affecting the rate of postoperative recurrence were reoperation (p = 0.0199), positive margins (p < 0.0001), and postoperative radiation therapy (p = 0.0027). Eleven patients (22%) required reoperation at a median of 24.6 months postoperatively (range 11 to 78 months).Conclusions. Desmoid tumors involving the chest and adjacent structures are locally aggressive tumors with a high recurrence rate. Wide radical resection should be attempted whenever possible. Positive margins at resection, reoperation and postoperative radiation are associated with a high risk of local recurrence. (C) 2004 by The Society of Thoracic Surgeons.