METHODS: A total of 185 patients who underwent unplanned resection were included. These patients were stratified into two groups: Group A (n = 156) underwent re-excision, while Group B (n = 29) was treated conservatively. Depending on the clinical scenario, radio- or chemotherapy was either administered in a neoadjuvant or an adjuvant setting. The presence of residual tumor and metastatic disease was documented. Clinical outcomes, specifically local recurrence (LR), local recurrence-free survival (LRFS) and overall survival (OS), were utilized for evaluation.
RESULTS: Group B exhibited significantly larger tumors (p < 0.0001) and a higher mean age than Group A. Among the patients in Group A, 11 (5.9%) had contaminated resection margins (R1), and residual disease (RD) was observed in 93 (59.6%) of the resected specimens. In group B, 10 patients received adjuvant radiotherapy alone, 5 received chemotherapy alone, and 13 underwent a combined approach consisting of both radio- and chemotherapy. In Group A, 8% (n = 12) of the patients developed local recurrence (LR) during the observation period. Conversely, in Group B, this amount was 14% (n = 4) (n.s.). Of the 12 LR in Group A, 10 were found in the subgroup with residual disease. Overall survival and local recurrence-free survival were not significantly different between the groups. A total of 15% (n = 24) of the patients in Group A developed metastatic disease, while 10% (n = 3) in Group B developed metastatic disease (n.s.).
CONCLUSIONS: Following the reresection of unplanned resected STS, there was no statistically significant difference observed in overall survival or LR compared to patients who did not undergo re-resection. However, within the subgroup of patients with residual disease in the re-resected specimen, the OS was compromised, and the LR rate was higher. Particularly for low-grade lesions, adopting a more conservative approach seems to be justified.
方法:共纳入185例接受非计划切除的患者。这些患者被分为两组:A组(n=156)接受了再次切除,B组(n=29)采用保守治疗。根据临床情况,放疗或化疗要么在新辅助治疗或辅助治疗中进行.记录了残留肿瘤和转移性疾病的存在。临床结果,特别是局部复发(LR),无局部复发生存率(LRFS)和总生存率(OS),用于评估。
结果:B组表现出明显更大的肿瘤(p<0.0001)和高于A组的平均年龄。在A组患者中,11例(5.9%)切除边缘(R1)受污染,在切除标本中观察到93例(59.6%)残留病(RD)。B组,10例患者单独接受辅助放疗,5只接受化疗,13例患者接受了由放疗和化疗组成的联合治疗.A组,8%(n=12)的患者在观察期间出现局部复发(LR)。相反,B组,这个数量是14%(n=4)(n.s.)。在A组的12名LR中,在残留病亚组中发现10例。两组之间的总生存率和无局部复发生存率没有显着差异。A组中共有15%(n=24)的患者发展为转移性疾病,而B组中10%(n=3)发生转移性疾病(n.s.)。
结论:非计划切除的STS再切除后,与未接受再切除术的患者相比,总生存期或LR无统计学显著差异.然而,在再次切除标本中残留疾病的患者亚组内,操作系统遭到破坏,LR率较高。特别是对于低度病变,采取更保守的方法似乎是合理的。