Cemil YILDIZ, Kaan ERLER, Serkan BİLGİÇ, A. Sabri ATEŞALP, Mustafa BAŞBOZKURT

Ekstremite yumuşak doku sarkomlarının tedavisinde cerrahi sınırların lokal kontrol ve sağkalım üzerine etkisi

Amaç: Ekstremite yumuşak doku sarkomu nedeniyle tedavi gören hastalarda cerrahi sınırların ve diğer prognostik faktörlerin lokal kontrol ve sağkalıma olan etkileri araştırıldı. Çalışma planı: Ekstremite yumuşak doku sarkomu tanısıyla tedavi edilen 40 hasta (34 erkek, 6 kadın; ort. yaş 45; dağılım 13-77) retrospektif olarak değerlendirildi. Yirmi altı hastanın ilk tanısı kliniğimizde kondu; 14 hasta daha önce tıbbi ve cerrahi tedavi görmüş nüks ile başvuran olgulardı. Cerrahi öncesinde dokuz olguda radyoterapi, sekiz olguda kemoterapi; ameliyat sonrasında 35 olguda radyoterapi, 25 olguda kemoterapi uygulandı. Otuz beş hastada (%87.5) ekstremite koruyucu cerrahi girişim, beş hastada (%12.5) amputasyon yapıldı. Ekstremite koruyucu cerrahi girişim olarak, 28 hastada (%70) geniş rezeksiyon, yedisinde (%17.5) marjinal eksizyon uygulandı. Tüm hasta grubunda, cerrahi sınırlar 34 hastada (%85) negatif, altısında (%15) pozitif bulundu. Ortalama izlem süresi 58 aydı (dağılım 13-124 ay). Sonuçlar: Beş hastada lokal nüks (%12.5) görüldü. Bunların dördünde marjinal eksizyon, birinde marjinal amputasyon uygulanmıştı. Geniş lokal eksizyon yapılan hastalarda ve negatif cerrahi sınıra sahip hastalarda lokal nükse rastlanmadı. Beş yıllık sağkalım, tanısı kliniğimizde konan hastalarda %51, nüks ile başvuran hastalarda %49 bulundu. Geniş lokal rezeksiyon (p=0.0001) ve negatif cerrahi sınır (p=0.0001) lokal kontrolle; tümör derecesi (p=0.002) sağkalımla anlamlı ilişkide bulundu. Pozitif cerrahi sınır ve lokal nüks sağkalım süresini azaltmadı. Çıkarımlar: Ekstremite yumuşak doku sarkomlarında negatif cerrahi sınır lokal kontrolü artırmaktadır. Ameliyat öncesinde uygun planlama ve neoadjuvan tedaviler ile negatif cerrahi sınırın mümkün olacağı unutulmamalıdır.

Anahtar Kelimeler:

Yumuşak doku neoplazileri, Seyir, Neoplazm nüksü, lokal, Tedavi sonucu, Kombine tedavi uygulaması, Sarkom, Sağkalım

The effects of surgical margins on local control and survival in extremity soft tissue sarcomas

Objectives: We evaluated the effects of surgical margins and other prognostic factors on local control and survival in extremity soft tissue sarcomas. Methods : The study included 40 patients (34 males, 6 females; mean age 45 years; range 13 to 77 years) who underwent treatment for extremity soft tissue sarcomas. Of these, 14 patients presented with recurrences following treatment elsewhere. Preoperatively, nine patients and eight patients; postoperatively, 35 patients and 25 patients received radiotherapy and chemotherapy, respectively. Limb-salvaging surgery was performed in 35 patients (87.5%), of whom 28 patients (70%) received an extended resection, and seven patients received a marginal resection. Five patients (12.5%) required amputation. Negative surgical margins were achieved in 34 patients (85%), while six patients (15%) had positive surgical margins. The mean follow- up period was 58 months (range 13 to 124 months). Results: Five patients (12.5%) developed local recurrences following marginal resection (n=4), and amputation. No local recurrences were seen in patients receiving an extended resection or in those having negative surgical margins. Five-year survival rates were 51% and 49% in patients whose initial diagnoses were made in our department and elsewhere, respectively. Significant correlations were found between extended resection (p=0.0001) and negative surgical margins (p=0.0001) and local control; and between tumor grade and survival (p=0.002). Positive surgical margins and local recurrences did not decrease survival. Conclusion: Achievement of negative surgical margins promotes local control in extremity soft tissue sarcomas. A careful preoperative planning and utilization of neoadjuvant therapies highly increase the possibility of negative surgical margins.

Keywords:

Soft Tissue Neoplasms, Prognosis, Neoplasm Recurrence, Local, Treatment Outcome, Combined Modality Therapy, Sarcoma, Survival,

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