Mesut MISIRLIOĞLU, İzzet BİNGÖL, Hüseyin ÇAKMAK, Hamit GÖKSU, Umut BARAN ZENGİN, Bedii Şafak GÜNGÖR

Marjinal rezeksiyon sonrası gelişen tek merkezli 31 elastofibroma dorsi vakalarında komplikasyonları etkileyen faktörler

Amaç: Elastofibroma dorsi (ED), genellikle beşinci dekattan sonra kadınlarda subskapular bölgede nadir görülen, benign bir bağ dokusu tümörüdür. Tek merkezde cerrahi olarak tedavi edilen ED vakalarının klinik özelliklerini, yönetimini ve uzun dönem sonuçlarını sunmayı amaçladık. Gereç ve Yöntem: Ocak 2010 ile Ocak 2021 tarihleri arasında histopatolojik olarak ED tanısı alan ve ortalama yaşları 56,6 olan 31 hastanın (7 erkek, 24 kadın) verileri hastane kayıtlarından retrospektif olarak incelendi. Ortalama takip süresi 80,2 (19-144) aydı. Dokuz vaka çift taraflıydı. Radyolojik ve klinik olarak tanı konulan tüm olgulara marjinal rezeksiyon cerrahisi uygulandı ve üç hastaya preoperatif biyopsi yapıldı. Sonuçlar takip sırasında ağrı için görsel analog skala (VAS) kullanılarak değerlendirildi. Bulgular: Ameliyat sonrası erken dönemde toplam 11 hastada (%35) sonradan takiplerde düzelen şu kompliksayonlar gözlenmiştir; kronik ağrı (n=5), hematom (n=5), seroma (n=5), enfeksiyon (n=2). Bir hastada takip sürecinde görülen lokal nüks re-eksize edildi. Bilateral ED'li hastalarda (p=0,015), ağır işlerde ve el emeği ile yapılan işlerde çalışanlarda (p=0,013), ek hastalığı olanlarda (p=0,006), sırtüstü yatanlarda (p=0,031), ve senkronize cerrahi geçiren (p=0,013) hasta gruplarında istatistiksel olarak anlamlı daha fazla komplikasyonlar gözlenmiştir. Ayrıca longitudinal uzunluğu fazla olan kitlelerde (p=0,016), ameliyat öncesi semptom süresi uzun olanlarda (p=0,009) ve ameliyat süresi uzun hasta gruplarında, (p=0,025) istatistiksel olarak anlamlı derecede daha fazla komplikasyon gözlendi. Ortalama VAS skoru preoperatif 4,97'den, postoperatif 1,52'ye kadar istatistiksel olarak anlamlı derecede düzelme gösterdi (p<0,001). Sonuç: Marjinal rezeksiyon sonrası uzun dönem takiplerde tatmin edici sonuçlar elde edilirken erken postoperatif dönemde birçok komplikasyonla karşılaşılır. Bu hastalarda semptomlar ve lezyonlar kapsamlı bir şekilde değerlendirildikten sonra rezeksiyon kararı verilmeli, hastalar komplikasyonlar konusunda bilgilendirilmeli ve titiz cerrahi sonrası takip süreleri uzatılmalıdır.

Anahtar Kelimeler:

Elastofibroma dorsi, marginal resection, subscapular mass, benign tumor

Factors affecting complications in 31 cases of elastofibroma dorsi after marginal resection in a single center

Aim: Elastofibroma dorsi (ED) is an uncommon benign connective-tissue tumor, usually seen in the subscapular region of women after the fifth decade. We present the clinical features, management, and long-term outcomes of cases of ED treated surgically in a single institution. Material and Method: The data of 31 patients (7 male, 24 female) with a histopathological diagnosis of ED between January 2010 and January 2021 and mean age of 56.6 years were reviewed retrospectively from their records. The mean follow-up duration was 80.2 (19-144) months. Nine cases were bilateral. Marginal resection surgery was performed in all cases diagnosed radiologically and clinically, and preoperative biopsies were performed for three patients. The results were evaluated using a visual analogue scale (VAS) for pain during follow-up. Results: Complications such as chronic pain (n=5), hematoma (n=5), seroma (n=5), and infection (n=2) were seen in 11 patients (35%) in the early postoperative period and improved over the course of follow-up. A local recurrence observed in one patient during follow-up was re-excised. Significantly more complications were observed in patients with bilateral ED (p=0.015), manual laborers and heavy laborers (p=0.013), patients with comorbidities (p=0.006), those who slept in the supine position (p=0.031), and those who underwent synchronized surgery (p=0.013). In addition, statistically significantly more complications were observed in cases of masses with longer longitudinal length (p=0.016), patients with longer preoperative symptom duration (p=0.009), and longer operative times (p=0.025). The average VAS score improved significantly from 4.97 to 1.52 after surgery (p<0.001). Conclusion: While satisfactory results were obtained over a long follow-up duration after marginal resection, many complications were encountered in the early postoperative period. The decision for resection should be made after a comprehensive evaluation of symptoms and lesions, patients should be informed about complications, and follow-up periods should be prolonged after meticulous surgery.

Keywords:

Elastofibroma dorsi, marginal resection, subscapular mass, benign tumor,

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Bartocci M, Dell’Atti C, Meacci E, et al. Clinical features, imaging findings, treatment aspects of elastofibroma dorsi and long-term outcomes after surgical resection. Eur Rev Med Pharmacol Sci 2017; 21: 2061-8.
Oliva MS, Smimmo A, Vitiello R, et al. Elastofibroma dorsi: What’s new? Orthop Rev (Pavia) 2020; 12: 8708.
Tepe M, Polat MA, Calisir C, Inan U, Bayav M. Prevalence of elastofibroma dorsi on CT: is it really an uncommon entity? Acta Orthop Traumatol Turc 2019; 53: 195-8.
Scamporlino A, Ruggiero C, Aramini B, Morandi U, Stefani A. Surgery for elastofibroma dorsi: optimizing the management of a benign tumor-an analysis of 70 cases. J Thorac Dis 2020; 12: 1884-94.
Deveci MA, Özbarlas HS, Erdoğan KE, Biçer ÖS, Tekin M, Özkan C. Elastofibroma dorsi: clinical evaluation of 61 cases and review of the literature. Acta Orthop Traumatol Turc 2017; 51: 7-11.
Karrakchou B, Yaikoubi Y, Chairi MS, Jalil A. Elastofibroma dorsi: case report and review of the literature. Pan Afr Med J 2017; 28: 34.
Nishio J, Nakayama S, Nabeshima K, Yamamoto T. Current update on the diagnosis, management and pathogenesis of elastofibroma dorsi. Anticancer Res 2021; 41: 2211-5.
Tamimi Mariño I, Sesma Solis P, Pérez Lara A, Martinez Malo J, Vazquez ML, Tamimi F. Sensitivity and positive predictive value of magnetic resonance imaging in the diagnosis of elastofibroma dorsi: review of fourteen cases. J Shoulder Elbow Surg 2013; 22: 57-63.
El Hammoumi M, Qtaibi A, Arsalane A, El Oueriachi F, Kabiri EH. Elastofibroma dorsi: clinicopathological analysis of 76 cases. Korean J Thorac Cardiovasc Surg 2014; 47: 111-6.
Nagano S, Yokouchi M, Setoyama T et al. Elastofibroma dorsi: surgical indications and complications of a rare soft tissue tumor. Mol Clin Oncol 2014; 2: 421-4.
Sahin M, Gul VO. Is it necessary to always resect elastofibroma dorsi? ANZ J Surg 2021; 91; 304-9.
Findikcioglu A, Kilic D, Karadayi Ş, Canpolat T, Reyhan M, Hatipoglu A. A thoracic surgeon’s perspective on the elastofibroma dorsi: a benign tumor of the deep infrascapular region. Thorac Cancer 2013; 4: 35-40.
Giebel GD, Bierhoff E, Vogel J. Elastofibroma and pre-elastofibroma--a biopsy and autopsy study. Eur J Surg Oncol 1996; 22: 93-6.
Pilge H, Hesper T, Holzapfel BM, Prodinger PM, Straub M, Krauspe R. Elastofibroma: clinical results after resection of a rare tumor entity. Orthop Rev (Pavia) 2014; 6: 5329.
Cavadas PC, Almoguera-Martinez A, Idriss H. Unusual late complication of latissimus dorsi free flap donor site: elastofibroma dorsi. Plast Reconstr Surg Glob 2022; 10: e4090.
Nagamine N, Nohara Y, Ito E. Elastofibroma in Okinawa. A clinicopathologic study of 170 cases. Cancer 1982; 50: 1794-805.
Parratt MT, Donaldson JR, Flanagan AM et al. Elastofibroma dorsi: management, outcome, and review of the literature. J Bone Joint Surg Br 2010; 92: 262-6.
Sezer HF, Eliçora A, Topcu S, Abdullayev G. Elastofibroma dorsi: tek merkez deneyimi/ Elastofibroma dorsi: single center experience. Cerrahi Tıp Bilimleri/Surgical Sciences 2021; 74: 264-8.
Lococo F, Cesario A, Mattei F et al. Elastofibroma dorsi: clinicopathological analysis of 71 cases. Thorac Cardiovasc Surg 2013; 61: 215-22.