The Result of Re-excision Following Unplanned Excision of Soft Tissue Sarcoma of the Extremities / 대한정형외과학회잡지

PURPOSE: This study examined the effect of a microscopic residual tumor on the survival and recurrence rate by analyzing patients who had undergone a re-excision after an unplanned excision of a soft tissue sarcoma. MATERIALS AND METHODS: From December 1985 to June 2002, 68 unplanned excisions of a soft tissue sarcoma at other institutes were referred to our service. All cases had undergone a re-excision and were re-evaluated for residual tumors. The male to female ratio was the same with an average age of 34.7 years. Staging followed the AJCC classification and there were 3 cases of Ia, 2 Ib, 5 IIa, 34 IIb, 24 III. Twenty six cases underwent surgical treatment only and 42 had added adjuvant therapy. The mean follow-up was 58.9 months. RESULTS: At the final follow up, there were 48 CDF, 9 NED, 3 AWD and 8 DOD. The CDF 5/16 year survival rates were 68.1/61.3%. Eight of the 23 residual tumor positive cases and 6 of the 45 residual tumor negative cases had a local recurrence. The tumor size, residual tumor, interval between the excision and reexcision, and stage were significant factors for a local recurrence. Statistical analysis revealed a local recurrence, metastasis and stage to be significant factors for survival. CONCLUSION: Local recurrence was the only controllable factor for survival. The presence of a residual tumor had an impact on the local recurrence. A re-excision after an unplanned excision may reduce the incidence of a local recurrence.

Treatment of Infected Tumor Prosthesis in Malignant Bone Tumor / 대한정형외과학회잡지

PURPOSE: The analysis points used in this study were the features, durations, and outcomes following different treatment modalities for an infected tumor prosthesis (TP). These were used to define an appropriate strategy for infected TP. MATERIALS AND METHODS: From December 1986 to November 1999, 215 patients underwent a TP replacement operation in our hospital, and 17 patients with an infected TP were eligible for the study. Forty-two operative procedures were performed on 17 patients (scarectomy 11 cases, partial TP removal and bone cementation 9 cases, complete TP removal and bone cementation 20 cases, and amputation 2 cases). Freedom from infection was defined as no sign of inflammation for 3 months after the operation and its objective variables were CRP, ESR, physical examination, and culture free body fluid. Although one patient received several procedures, we considered each event as a separate variable. The survival rates of the procedures were analysed by Kaplan-Meier plots and these were compared using the log rank test. RESULTS: The cumulative survival of each procedure was 0% by scarectomy at 11 months, 0% by partial TP removal and bone cementation at 12 months, and 34% by complete TP removal and bone cementation at 79 months. Significant differences in survival were found for these procedures (p<.001). CONCLUSION: Aggressive initial management reduces patient's pain and increases the chance of returning to the original functional status.

Long Term Survival of Synovial Sarcoma and Treatment Strategy / 대한정형외과학회잡지

PURPOSE: The object of the current study was to evaluate the long term survival of synovial sarcoma and to find an appropriate treatment strategy with a favorable prognosis. MATERIALS AND METHODS: Between August 1985 and June 2000, fifty nine synovial sarcoma patients without metastasis at presentation were analyzed and followed for 50.9 (8-161) months. Kaplan-Meier plots were used for survival analysis. Analyzed prognostic factors were sex, age, stage, location, surgical margin, chemotherapy, radiation therapy, local recurrence and metastasis. The log-rank test was used for univariate analysis and the Cox regression model for multivariate analysis. RESULTS: Fourteen-year actual and continuous disease free survivals (ADF/CDF) were 56.4 and 49.7%, respectively. CDF of stage I-IIa and IIb-III were 53.6 and 43.2%, respectively (p=0.55). For local recurrence according to surgical margin, 4 recurrences occurred in 44 wide margins, 1 recurrence in 6 marginal margins, and 1 recurrence in 2 intralesional margins. Among 10 cases of local recurrence, 4 cases had metastasis. Local recurrence, metastasis, and surgical margin had statistical significance in the univariate (p< 0.0001, p<0.0001, p=0.011) and multivariate analysis. CONCLUSION: Fourteen year CDF survival was 49.7%. The alleviation of local recurrence and metastasis is essential for long term survival. In the current study, the only factor under our control was surgical margin. A well designed surgical approach will reduce the recurrence rate.