Surgical site infection in malignant soft tissue tumors

Background  

Postoperative wound complications, including surgical site infections, which frequently occur in the course of management of musculoskeletal sarcomas, sometimes necessitate repeat surgeries, including amputation, and may result in a prolonged healing time, prolonged hospital stay, or fatal outcome. A comprehensive understanding of surgical site infections associated with specific diseases is needed to reduce the risk.     

Surgical, combined and comprehensive treatment of malignant soft tissue tumors

According to the authors' data the total 5 years' survival among 444 cases, subjected to radical operations for malignant tumors of the soft tissues, constituted 51.6% and proved to be practically the same both in primary and recurrent tumors. The improvement of the 5 years' results of the combined treatment (surgery and radiotherapy) of soft tissue sarcoma was noted, even when taking into account the stage of the disease and cellular differentiation of the tumor.     

上肢软组织恶性肿瘤的手术治疗和预后

目的 总结10年来上肢软组织恶性肿瘤的分类、发生、发展、治疗及预后。方法 对22例上肢软组织恶性肿瘤，采用手术治疗将肿瘤及边缘的正常组织一并切除，尽量保留肢体及其重要血管和神经，以保存上肢功能。行神经移植修复3例，带蒂皮瓣覆盖创面8例。对10例复发病例再次切除肿瘤组织后，进行化学治疗和放射治疗等综合治疗。结果 术后随访最短3个月，最长10年半，平均5年；其中2例滑膜肉瘤于术后1年因远处转移而死亡，其余病人无远处转移。5年生存率为87．5％，生存5年以上者共14例。局部复发14例，复发率为70％；由于多次复发最终上肢截肢1例，手指截指2例，肢体保存率为85％。结论 上肢软组织恶性肿瘤以手术治疗为主，辅以化学治疗和放射治疗等综合治疗。     

Diagnosis of malignant bone and soft tissue tumors

Primary sarcoma of bone is a rare entity but nevertheless a significant cause of mortality in children and adolescents. The focus of the preoperative evaluation is to set up a histological diagnosis, define local tumor extent and develop a therapy regimen. In addition to patient history and clinical findings a radiograph in two orthogonal planes is still of great importance. MRI plays a major role in the further clarification of the diagnosis, while CT is valuable in the diagnosis of tumors of the axial skeleton as well as in systemic staging. A PET-CT can be performed to obtain an overview of further tumor sites. Open bone biopsy is the final diagnostic step and should be carried out at the institution where the definitive treatment will be performed. Complications such as fracture, neural lesions and spread of tumor cells are relatively rare if the biopsy is performed appropriately; however, patients should be instructed to strictly avoid weight-bearing on the affected extremity.     

Additional wide resection of malignant soft tissue tumors.

Forty-five patients with soft tissue sarcomas received additional wide resections after they were treated with simple excision by a primary physician. Of the patients in the current study, 26 were male and 19 were female; all were treated between 1986 and 1998 for malignant soft tissue tumors. The mean followup was 7.1 +/- 3.4 years. The mean time from first excision to additional wide resection was 8 weeks, and for 90% of the patients it was within 12 weeks. In deciding the surgical margin for an additional operation, enhanced computed tomography scans and magnetic resonance images were done. Four (8.8%) patients had local recurrences that required a second resection and had no evidence of disease at latest followup. Four (8.8%) patients had distant metastases but did not have local recurrences. Three patients died of lung metastases. The overall 5-year survival rate of the patients was 93%, and the overall 5-year disease-free rate was 84%. It seems that tumors treated adequately by wide resection in an additional operation have results as good as tumors treated with a primary wide resection.     

体表恶性肿瘤和顽固性创面的整形外科治疗

目的 探讨结合应用整形外科的技术治疗体表恶性肿瘤和顽固性创面的优越性.方法 根据体表恶性肿瘤和顽固性创面的性质、部位和大小,将恶性肿瘤边缘以及基底3～5 cm正常组织切除,顽固性创面彻底清创,再根据组织缺损的部位和面积,选择邻近部位的带蒂皮瓣或肌皮瓣、游离皮瓣即刻修复.结果 2003至2006年临床应用21例,所有皮瓣完全成活,术后随访2～3年,体表恶性肿瘤除1例复发需再次手术切除重新修复外,其他病例无复发且外形恢复良好;顽固性溃疡创面完全愈合.结论 将整形外科技术结合应用于体表恶性肿瘤和顽固性溃疡创面的治疗,术后能得到更好的恢复,得到更好的效果.     

Chemosensitivity testing by regrowth assay against malignant bone and soft tissue tumors

In order to improve the clinical results of chemotherapy protocols for patients with malignant bone and soft tissue tumors, an attempt was made to establish a methodological approach to chemo-sensitivity testing using a modified regrowth assay system. We have established a chemo-sensitivity testing system using methylcholanthrene-induced round cell sarcoma in BALB/c mouse. This system was applied clinically and the sensitivity to anticancer drugs was found within two weeks of cell culture. Fifteen patients with malignant tumors were treated using a chemotherapy protocol composed of drugs selected by means of our system. Eleven patients (73.3%) showed an excellent therapeutic response. Our simple assay system is available to determine sensitivity to drugs in a short time. Drugs with no sensitivity can be eliminated from the protocol so that adverse effects on normal tissue can also be reduced.     

Surgical treatment concepts in soft tissue tumors of the locomotor system

Soft tissue tumors of the extremities require a definitive histopathological diagnosis and adequate treatment unless they are known to have been present for years without any clinical change. For lesions with a straightforward clinical diagnosis (ganglion of the wrist) and for superficial tumors smaller than 3 cm, excisional biopsy is adequate. For all other lesions an open incisional biopsy should be performed. If the lesion is potentially malignant, all the appropriate staging studies must be performed before biopsy; if the tumor has been biopsied without prior staging and unexpectedly reveals a malignant lesion, complete staging must be performed before definitive surgery is undertaken. Soft tissue sarcomas extend rapidly within the tissue of the compartment they originated in, but tend to respect compartmental boundaries. Radical resection of the entire compartment containing the sarcoma is thus the surgical treatment of choice. Adjuvant radio- and/or chemotherapy are necessary in the majority of these cases and should be integrated into the treatment strategy.     

Malignant soft tissue tumors

This article is a survey of actual aspects. With regard to frequency, the malignant fibrous histocytoma comes first, followed by lipo- and fibrosarcoma, synovial sarcoma, malignant schwannoma, malignant tumours proceeding from arteries and veins and the unstriated musculature. Staging and grading of these tumours are difficult. Until now their overall TNM-classification was not possible due to insufficient hard criteria.     

Giant cell tumors of soft tissue: a clinicopathologic study of 18 benign and malignant tumors

Primary giant cell tumors (GCTs) of soft tissue resembling osseous GCTs are uncommon but distinct entities. Malignant GCTs of soft tissue have been designated giant cell malignant fibrous histiocytomas; however, there is scant data regarding benign GCTs of soft tissue. Eleven benign and seven malignant GCTs of soft tissue were identified from the authors' consultation files and the surgical pathology files of the Vancouver General Hospital and Massachusetts General Hospital. The tumors occurred in adults (eight men, 10 women; age range, 25-89 years; mean age, 54 years) in the extremities (n = 14) and in the trunk, abdomen, and pelvis (n = 4). In each patient the skeleton was normal and there was no history of prior osseous GCT. Tumors ranged in size from 0.8 to 9.0 cm. Eleven occurred in the superficial soft tissue and seven occurred in deep soft tissue. Grossly they were circumscribed and frequently hemorrhagic. Cystic change was present in seven tumors. Nine tumors were partially surrounded by a shell of reactive bone. In all tumors, multinucleated osteoclast-like giant cells were distributed uniformly and evenly among mononuclear cells. The histologically benign GCTs of soft tissue were identical to typical osseous GCTs. The mononuclear cells in these tumors lacked nuclear atypia or pleomorphism, and the mitotic rate within this population was low (mean, three mitoses per 10 high-power fields [HPF]). In the malignant GCTs of soft tissue, the mononuclear cells exhibited anisocytosis, nuclear atypia, pleomorphism, and readily detectable mitoses including atypical forms (mean, 25 mitoses per 10 HPF). None of the benign or malignant tumors exhibited neoplastic bone production. The benign and malignant GCTs of soft tissue demonstrated a similar immunohistochemical staining profile to GCT of bone ( 12 tumors examined), exhibiting strong positive staining for CD68 within multinucleated osteoclastlike cells, and focal staining of mononuclear cells for CD68, Ham 56, and smooth muscle actin. All tumors were treated by surgical resection. Follow-up information is available for 15 patients (range, 0-108 months). No benign tumor has recurred or metastasized. Of the four patients with malignant tumors for whom follow-up information is available, one died of metastatic disease at 13 months and one developed a local recurrence at 84 months but is alive, apparently free of disease after additional excisional surgery. Primary GCTs of soft tissue are distinctive neoplasms that, like osseous GCTs, exhibit a wide clinicopathologic spectrum. These neoplasms should be distinguished from other giant cell-rich soft-tissue tumors with which they may be confused.     

拇指软组织恶性肿瘤19例临床分析

目的探讨拇指软组织恶性肿瘤的发病特点及治疗体会。方法对2000--2012年收治的具有明确病理诊断的19例拇指软组织恶性肿瘤,就其发病特点、,临床表现及手术治疗进行回顾性分析。结果拇指软组织恶性肿瘤以黑色素瘤和鳞状细胞癌多见。保留拇指功能截指组与超掌指关节截指组术后生存率差异有统计学意义（P〈O．05）。结论对于拇指软组织恶性肿瘤争取早发现、早诊断、早治疗,为了提高术后生存率,首选掌指关节截指术。     

Surgical site infection surveillance

Surgical site infections (SSI) are major complications after surgical procedures, since they prolong the hospital stay, increase treatment costs and diminish patient satisfaction markedly. In the United States SSI surveillance is carried out in the framework of the NNIS system; at present more than 300 medical institutions are participating. In comparison with Europe and the United States SSI surveillance had a late start in Japan. The Japanese Society of Environmental Infections established the Japanese Nosocomial Infection Surveillance System in 1998 and initiated SSI surveillance in the same year. Up to October 2003, in total 20,948 cases from 36 institutions have been registered. SSIs occurred in 1,394 cases, this corresponds to an incidence of 6.7%. When we look at the numbers of SSIs by the organs operated on, the incidence figures in the field of gastrointestinal surgery were by far the highest ones. Since July 2002, 50 institutions all over Japan are participating in SSI surveillance that has developed into a national scheme under the auspices of the Japanese Ministry of Health and Welfare. The activities supervised by the Ministry will for some time be limited to these 50 institutions. Aiming at a further spread and quality enhancement of SSI surveillance in Japan in October 2002 the SSI Surveillance Study Meeting was founded. It is anticipated that through the activities of this organisation a large number of institutions will participate in SSI surveillance, that reliable surveillance data will established and that SSIs will decrease in Japan.     

Chemotherapy of soft tissue tumors

The use of chemotherapy in the treatment of patients with advanced soft tissue sarcoma and as adjuvant and neoadjuvant therapy is reviewed. In advanced disease a response rate of up to 35% can be achieved with combination chemotherapy, but these are mainly partial remissions; few complete remissions are attained. The median survival for patients in partial remission is 2 years. The most active cytotoxic drug is adriamycin, with a remission rate of 30%. The addition of dacarbazine can increase the remission rate; however, this has no significant impact on survival and the toxicity is more pronounced. The activity of neoadjuvant or adjuvant chemotherapy is still controversial. Some studies indicate a positive effect on disease-free or overall survival with adriamycin-containing regimens. Other studies have not confirmed these results. More controlled trials with adequate numbers of patients stratified for tumor subtype, tumor localization and grading are needed to define the value of adjuvant or neoadjuvant chemotherapy in soft tissue sarcomas. Optimal interdisciplinary treatment can only be realized at specialized centers.