Background: Myxofibrosarcomas are notoriously highly infiltrative soft-tissue sarcomas, making negative surgical margins difficult to obtain. Recently, vacuum-assisted closure (VAC) is used to delay wound closure until a negative margin has been achieved; however, this can delay care and increase costs. Our institution has historically performed single-stage resections with intraoperative frozen margin analysis and reconstruction in these patients. The purpose of this study is to report the outcomes of this technique. Methods: We reviewed 112 patients (62 males, mean age 70 ± 14 years) with superficial myxofibrosarcoma. Eighty-eight patients received preoperative radiation. All patients underwent surgical resection with intraoperative frozen margin analysis, and the planned reconstruction was performed in a single anesthetic. Results: The 10-year local recurrence-free survival was 90%; positive intraoperative frozen section (HR 7.44,p= 0.004) and final permanent margins (HR 8.53,p= 0.007) were associated with local recurrence. Intraoperative margins were negative in 103 (92%) of patients, 1 of which was positive on final permanent section. There were nine cases of microscopically positive margins, of which seven underwent immediate re-excision to a negative margin. The accuracy of frozen margin assessment for myxofibrosarcoma was between 92.92 and 98.23%. All patients underwent reconstruction at the time of resection, with 19% needing an additional procedure, most commonly due to a wound complication (12%). Conclusions: Multidisciplinary single-stage excision with intraoperative frozen margin assessment and soft-tissue reconstruction yields low rates of local recurrence in patients with superficial myxofibrosarcoma.
背景：黏液纤维肉瘤是一种以高度浸润性著称的软组织肉瘤，手术中难以获得阴性切缘。近年来，负压伤口疗法被用于延迟伤口闭合直至获得阴性切缘，但这种方法可能延误治疗并增加成本。本机构长期以来对这类患者采用术中冰冻切缘分析联合一期切除重建术。本研究旨在报告该技术的临床效果。 方法：我们回顾了112例浅表性黏液纤维肉瘤患者（男性62例，平均年龄70±14岁）。其中88例接受术前放疗。所有患者均接受术中冰冻切缘分析指导下的手术切除，并在单次麻醉中完成计划性重建。 结果：10年局部无复发生存率达90%；术中冰冻切缘阳性（风险比7.44，p=0.004）与最终石蜡切缘阳性（风险比8.53，p=0.007）均与局部复发相关。103例（92%）患者术中切缘为阴性，其中1例最终石蜡切片显示阳性。共发现9例镜下切缘阳性病例，其中7例立即接受再切除直至获得阴性切缘。黏液纤维肉瘤冰冻切缘评估准确率介于92.92%至98.23%之间。所有患者均在切除同期完成重建，19%需要二次手术，最常见原因为伤口并发症（12%）。 结论：对于浅表性黏液纤维肉瘤患者，采用术中冰冻切缘评估联合软组织重建的多学科协作一期切除术，可实现较低的局部复发率。
Staged Reconstruction Is Not Necessary Following Oncologic Resection of Superficial Myxofibrosarcoma
肿瘤(癌症)患者之家