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Wiener klinische Wochenschrift

, Volume 123, Issue 15–16, pp 488–495 | Cite as

Compartmental resection for subfascial extremity soft tissue sarcoma and quality of life in long-term survivors

  • Matthias Peiper
  • Hanno Matthaei
  • Edwin BölkeEmail author
  • David Zurakowski
  • Klaus Orth
  • Antje Heinecke
  • Wolfram Trudo Knoefel
Original article

Summary

The surgical management of soft tissue sarcoma has changed over the past years, resulting in an interdisciplinary multimodal approach and limb-preserving treatment modalities. From 464 consecutive patients with a soft tissue sarcoma (STS) of an extremity, a compartmental resection was performed in 82 patients, usually for primary subfascial large tumors. Postoperative quality of life was evaluated using the EORTC Score C30. In our study population, 52% of STS was poorly differentiated, 32% moderately, and 16% well differentiated. Survival proved to be dependent on tumor grade and tumor biology, but not on tumor size. The overall survival rate was 81.5%, 71.9%, and 58.3% after 2, 3, and 5 years, respectively. Leiomyosarcoma (39%) and malignant fibrous histiocytoma (42%) are associated with poor 5-year survival rate compared to liposarcoma (82%). Metastases were observed in 33% of T1 and 43% of T2 tumors corresponding to 51% with G3 tumors, 52% with G2 and 23% with G1 tumors. We found a decreased quality of life score in our patients in all dimensions compared to a normal population. Despite the elevated risk of a functional deficit, compartmental resection reduces the risk of local recurrence comparable to the recurrence rates after the most radical surgery limb amputation.

Keywords

Soft tissue sarcoma Life quality sarcoma 

Kompartmentresektion des subfaszialen Extremitäten-Weichteilsarkoms und Lebensqualität bei Langzeit-Überlebenden

Zusammenfassung

HINTERGRUND: Die chirurgische Behandlung von Weichteilsarkomen hat sich in den letzten Jahren stark verändert. Heute werden Patienten interdisziplinär multimodal behandelt. Bei großen Extremitätensarkomen wird oftmals eine Kompartmentresektion durchgeführt, auch wenn der onkologische Benefit letztlich noch nicht eindeutig bestätigt werden konnte. Ein Argument dafür sind die immer wieder nachgewiesenen Satellitenmetastasen im Kompartment. Hinzu kommt, dass der Versuch der Extremitätenerhaltung (im Vergleich zur primären Amputation) heute Therapieziel der Wahl ist. Letztlich liegen hier aber nur wenige Untersuchungen über den onkologischen Langzeitverlauf vor. Untersuchungen über die Lebensqualität sind fast nicht vorhanden. PATIENTEN UND METHODIK: 464 Patienten mit einem Weichteilsarkom (STS) einer Extremität wurden prospektiv gesammelt und retrospektiv ausgewertet. Eine Kompartmentresektion bei einem subfaszialen Tumor wurde bei 82 Patienten durchgeführt. Die Histologie und das Tumorstadium wurden erfasst, ebenso die klinischen Daten (Rezidiv, Überleben) und eine mögliche adjuvante Therapie. Die postoperative Lebensqualität wurde mit Hilfe des EORTC QLQ-C30 Fragebogens (www.eortc.be/home/qol) ausgewertet. ERGEBNISSE: In unserer Erhebung waren 52 % der STS schlecht, 32 % mäßig und 16 % gut differenziert. Das Gesamtüberleben war signifikant abhängig von Tumorgrad und der Tumorbiologie, nicht aber auf die Tumorgröße. Die Gesamtüberlebensrate betrug 81,5 %, 71,9 % und 58,3 % nach 2, 3 und 5 Jahre. Leiomyosarkome (39 %) und maligne fibröse Histiozytome (42 %) hatten eine schlechtere 5-Jahres-Überlebensrate im Vergleich zu Liposarkome (82 %). Metastasen wurden in 33 % der T1 und in 43 % bei T2 Tumoren gefunden. Bei G3-Tumoren entwickelten im weiteren Verlauf 51 % der Patienten Metastasen, während die bei G2-Tumoren 52 % und bei G1-Tumoren 23 % der Fall war. SCHLUSSFOLGERUNG: Die Lebensqualität war bei allen unseren Sarkompatienten im Vergleich zur Normalbevölkerung reduziert, aber überwiegend noch in einem recht hohen Bereich. Auch wenn Vergleiche zu einer Patientengruppe mit primärer Amputation oder mit weiter Resektion hier nicht angestellt werden konnten, verringerte die Kompartment-Resektion das Risiko eines lokalen Rezidivs und war vergleichbar mit der historischen Rezidivrate nach einer weiten Resektion oder Amputation in der Literatur.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Matthias Peiper
    • 1
  • Hanno Matthaei
    • 1
  • Edwin Bölke
    • 2
    Email author
  • David Zurakowski
    • 3
  • Klaus Orth
    • 4
  • Antje Heinecke
    • 5
  • Wolfram Trudo Knoefel
    • 1
  1. 1.Klinik für Allgemein-, Viszeral- und KinderchirurgieHeinrich-Heine-UniversitätDüsseldorfGermany
  2. 2.Klinik für Strahlentherapie und RadioonkologieHeinrich-Heine-UniversitätDüsseldorfGermany
  3. 3.Departments of Biostatistics and Orthopaedic SurgeryChildren's Hospital, Harvard Medical SchoolBostonUSA
  4. 4.Klinik für ChirurgieKrankenhaus Hannover NordstadtHannoverGermany
  5. 5.Chirurgische KlinikUniversitätsklinikum Hamburg-EppendorfHamburgGermany

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