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Resektionsgrenzen bei Weichgewebssarkomen der Extremitäten

Surgical margins in soft tissue sarcoma of the extremities

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Zusammenfassung

Im multimodalen Therapiekonzept von Weichgewebssarkomen der Extremitäten stellt die operative Entfernung in sano (R0) einen wesentlichen Parameter zur Verhütung von Lokalrezidiven dar; die prognostische Relevanz für das Langzeitüberleben wird noch uneinheitlich beurteilt. Obwohl seit über 100 Jahren Empfehlungen oder Richtlinien definiert und mit Vehemenz vertreten werden, existieren bisher keine Daten mit hohem Evidenzgrad aus prospektiv randomisierten Studien, die die Sicherheitsabstände unter Berücksichtigung der Parameter „Tumorlokalisation“, „Subtyp“ und „biologische Aggressivität“ evaluieren. Die Empfehlungen bezüglich der chirurgischen Therapie divergieren beträchtlich. Sie reichen von der Amputation über die „Kompartmentresektion“ zur Zentimetergrenze bis hin zu Sicherheitsabständen im Millimeterbereich. In dieser Arbeit werden die aktuell erhältlichen Daten und Definitionen analysiert, ferner ihre Bedeutung für Funktionseinschränkung, Lymphabflussstörung, Rezidivquoten und Planung eines perioperativen Bestrahlungsfelds erörtert. Da keine einheitlichen operativen Standards existieren, entstehen Zweifel an der Validität bisher durchgeführter und laufender Multicenterstudien. Eine enge Kooperation zwischen Operateur und Pathologen scheint dringend geboten, um die Aussagekraft der Gewebeuntersuchungen zu erhöhen.

Abstract

Negative surgical margins (R0 resection) play a key role in the prevention of local recurrences of soft tissue sarcoma of the extremities in the multimodal therapy concept. The prognostic relevance for long-term survival is still under dispute. Despite the fact that numerous recommendations and guidelines have existed for over 100 years, strong evidence-based data from prospective randomized studies are still not available today. These studies should include parameters like tumor localization, subtype and biological aggressiveness. Recommendations as to surgical therapy diverge considerably. They range from amputation and compartment resection to centimetre and millimetre surgical margins. The present article analyses currently available data and definitions and discusses the impact on functional restriction, lymph drainage, local recurrence and the perioperative irradiation field. In the absence of surgical standards, it is doubtful whether existing studies and multicenter trials currently underway are valid. Close co-operation between surgeon and pathologist is imperative to further substantiate the significance of histological examinations and resection margins.

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Authors and Affiliations

  1. Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Weichgewebssarkome, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürckle-de-la Camp Platz 1, 44789, Bochum, Deutschland

    H.-U. Steinau, L. Steinsträsser, S. Langer & O. Goertz

  2. Institut für Pathologie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Deutschland

    I. Stricker

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  1. H.-U. Steinau
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  2. L. Steinsträsser
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  3. S. Langer
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  4. I. Stricker
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  5. O. Goertz
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Correspondence to H.-U. Steinau.

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Widmung

Herrn Emeritus Prof. Dr. med. Dr. med. h.c. mult. Friedrich Stelzner zum Geburtstag in alter Verbundenheit.

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Steinau, HU., Steinsträsser, L., Langer, S. et al. Resektionsgrenzen bei Weichgewebssarkomen der Extremitäten. Pathologe 32, 57–64 (2011). https://doi.org/10.1007/s00292-010-1394-y

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  • DOI: https://doi.org/10.1007/s00292-010-1394-y

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