原发性腹膜后脂肪肉瘤复发和预后的影响因素

目的:探讨原发性腹膜后脂肪肉瘤复发和预后的影响因素。方法:回顾性分析2011年6月至2020年1月郑州大学第一附属医院接受手术治疗的89例原发性腹膜后脂肪肉瘤患者的临床资料,男42例,女47例。中位年龄53(26~78)岁。我院首次手术治疗65例,外院术后复发再次手术治疗24例。初诊临床表现：体检发现腹膜后肿物41例,...     

腹膜后脂肪肉瘤外科治疗及其术后复发的多因素分析

目的:探讨腹膜后脂肪肉瘤(RPLS)的诊疗经验,并寻找影响RPLS术后复发的因素。方法:收集并回顾性分析84例RPLS病人临床病理特征、外科处理方法及影响术后复发的因素。结果:84例病人共行手术110例次,肿瘤完全切除72例次(65.5%),联合周围脏器切除66例次(60.0%)。术后总复发率64.3%,中位复发时间10个月。多因素分析显示RPLS分化程度和肉眼完全切除是影响术后复发的独立因素。联合脏器切除组与单纯肿瘤切除组的肉眼完全切除率分别为72.7%、54.5%,差异有统计学意义(P<0.05)。结论:RPLS术后复发率高,肿瘤分化程度和肉眼完全切除是影响RPLS术后复发时间的独立因素。联合周围脏器的肿瘤切除可明显提高肿瘤的完全切除率。     

腹膜后脂肪肉瘤完整切除后短期复发的影响因素分析

目的探讨腹膜后脂肪肉瘤经外科手术完整切除后短期复发的影响因素。方法回顾性分析2000年1月至2020年1月在解放军总医院第一医学中心普通外科行腹膜后脂肪肉瘤切除术的91例患者的临床和病理学资料。男性60例, 女性31例, 年龄(52.1±9.9)岁(范围:30～84岁)。将完整切除后12个月内发生的肿瘤复发定义为短期复发, 超过12个月发生的肿瘤复发定义为非短期复发。对腹膜后脂肪肉瘤完整切除后短期复发的影响因素进行分析, 组间比较采用t检验、秩和检验、χ2检验和Fisher确切概率法, 多因素分析采用Logistic回归分析, 以Kaplan-Meier曲线计算无复发生存时间, Log-rank检验进行组间比较。结果 91例患者中, 42例为短期复发, 49例为非短期复发。单因素分析结果显示, 肿瘤形态不规则、多种病理学亚型、病理评分>3分、多原发肿瘤是腹膜后脂肪肉瘤完整切除后短期复发的影响因素(χ2值为4.422～7.773, P值均<0.05)。多因素分析结果显示, 多原发肿瘤是腹膜后脂肪肉瘤完整切除后短期复发的独立影响因素(OR=2.918, 95%CI:1.127～...     

复发的原发性腹膜后脂肪肉瘤76例临床研究

目的 探讨复发的原发性腹膜后脂肪肉瘤的治疗方法.方法 回顾性分析1999年至2008年收治的76例复发的原发性腹膜后脂肪肉瘤患者临床资料.结果 74例再手术,共行126例次手术,首次复发、再次复发、三次以上复发肿瘤完全切除率分别是62.2%、26.8%、11.4%.肿瘤完全切除组1、3、5年生存率分别是84.5%、71.7%、58.2%(P<0.01),肿瘤部分切除组1、3、5年生存率分别为70.6%、39.3%、21.8%(P<0.01).结论 肿瘤切除不彻底是导致复发的主要原因.复发后再手术是首选治疗,充分做好手术前准备,提高肿瘤完全切除率,争取联合脏器切除达到完全切除是改善预后的关键.对复发的肿瘤应于适当的时机再次手术,并采取恰当的方案.     

原发性腹膜后脂肪肉瘤的外科治疗

目的探讨原发性腹膜后脂肪肉瘤（PRPI_S）的外科治疗方法。方法回顾性分析1996年1月至2008年3月经手术治疗17例PRPLS患者的治疗效果。结果17例患者共进行手术30例次,其中13例次为首次手术,17例次为再次手术。肿瘤完整切除24例次（80．0％）,其中联合脏器切除12例次（40．0％）,肿瘤部分切除5例次（16．7％）,探查活检1例次（3．3％）。结论原发性腹膜后脂肪肉瘤无论是首发还是复发,手术切除都是标准的治疗手段,晚期肿瘤姑息切除亦能减轻邻近压迫症状,改善患者生存质量,延长生存时间。     

原发性腹膜后脂肪肉瘤16例临床分析

原发性腹膜后脂肪肉瘤在临床上虽不常见，但也不是很少见，因其发病部位深在，难以早期发现，即使诊断明确后行手术切除，也经常复发。我们回顾分析了我院1994—2003年收治的16例原发性腹膜后脂肪肉瘤病例，结合近年来的相关文献，对该病例的临床特点及治疗作初步的探讨。     

原发性腹膜后脂肪肉瘤的诊断与治疗

目的 探讨原发性腹膜后脂肪肉瘤（primary retroperitoneal liposarcoma,PRPLS）的临床病理特点、诊治及预后.方法 对华中科技大学同济医学院附属协和医院普通外科初诊的43例PRPLS患者临床病理资料进行回顾性分析.结果 43例PRPLS患者中男性32例,女性11例,年龄22~75岁,中位年龄49岁.肿瘤平均大小（17.6＆#177;10.8） cm.行CT检查38例,定性准确率为81.3%;行MRI检查8例,定性准确率为80.0%.43例患者均接受手术,其中首次手术肿瘤完整切除者40例,联合切除率为32.5%,中位随访39个月,首次手术完整切除且未复发的患者3、5年生存率分别为85.0%、80.0%,术后复发患者3、5年生存率为72.2%、61.1%.结论 PRPLS早期诊断较为困难,CT和MRI是PRPLS诊断和术后复查的重要手段.PRPLS首次手术应争取完整切除肿瘤,对大多数复发病例仍应以积极手术治疗为主,完整切除仍可获得较好的预后.     

原发性腹膜后肉瘤预后研究进展

原发性腹膜后肉瘤在临床上较为少见,然而病理类型繁多。手术切除是其主要的治疗方法,但术后的高复发率是此类疾病治疗的一大困扰。此文分析总结了相关文献,结果显示腹膜后肉瘤病人的预后主要与病理类型、肿瘤级别、手术范围及肿瘤数目等有关。     

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目的 探讨原发性腹膜后及肠系膜脂肪肉瘤的外科治疗方法。方法 回顾性分析1993～2001年收治的18例原发性腹膜后及肠系膜脂肪肉瘤病人经手术治疗27例次的临床资料。结果 脂肪肉瘤占同期经手术探查的原发性腹膜后及肠系膜实体瘤的31．6％(18／57)；临床表现主要为进行性增大的腹部包块与消化道症状：病理类型以高分化型多见(13／18)；首诊后16例获得临床根治性切除，6例复发性脂肪肉瘤病人，共接受15次手术；全组合并单侧肾切除6例，部分结肠切除4例，部分空肠切除和胃大部切除各1例；肠系膜脂肪肉瘤手术多采用完整切除术(8／10)。结论 手术切除是目前唯一有效的治疗方法，必要时可行联合脏器切除术，但不应强求根治；为改善生存质量、延长生存期，对多发肿瘤不能完整切除者应积极实施姑息性减瘤术，多次复发者有条件可多次手术；采用完整切除术、尽量避免肠切除治疗对多发性及复发性肠系膜脂肪肉瘤具有重要临床价值。     

Giant recurrent retroperitoneal liposarcoma initially presenting as inguinal hernia: Review of literature

INTRODUCTIONLiposarcomas comprise around 15% of soft tissue tumors. These tumors of mesodermal origin arise as single tumors, present one histologic type and diverse locations (including the retroperitoneum). Diagnosis of liposarcomas of retroperitoneum is difficult because of this unspecific presentation and in 50–100% of the cases there is recurrence from residual tissue.PRESENTATION OF CASEAn 86 year old male patient was admitted in 1996 due to a right and voluminous inguinal hernia. During the herniaplasty, a right paratesticular tumor was isolated and removed. The histologic exam revealed a well-differentiated liposarcoma. A CT scan was performed and a large abdominal mass was detected. The patient underwent a laparotomy and an incomplete resection of the tumor was achieved. After the surgery the patient remained asymptomatic during a long period. Nine years later, the patient underwent another laparotomy with partial removal of the giant recurrent retroperitoneal liposarcoma.CONCLUSIONThe purpose of this publication is to report the recurrence of giant retroperitoneal liposarcoma, which is an unusual presentation in surgery today. Furthermore, we would like to emphasize the long-term survival of this patient despite partial resection and the possibility of performing a re-resection in this type of cases.     

Analysis of potential risk factors in the survival of patients with primary retroperitoneal liposarcoma

IntroductionThe present work is an observational study of a series of variables regarding overall survival and disease-free survival in patients diagnosed with primary liposarcoma.MethodsThe study is prospective with retrolective data collection that includes all patients with primary liposarcoma referred to Hospital Son Espases University Hospital, Palma de Mallorca, Spain from January 1990 to December 2019.ResultsThe study includes 50 patients and the compartment surgery was performed in 18 patients (36%) of cases. The mean overall survival of the sample was 15.57 years (95% CI: 12.02–19.12) and the mean disease-free survival was 6.70 years (95% CI: 4.50–8.86).ConclusionCompartment surgery has not shown benefits in terms of overall survival and disease-free survival. The ASA classification (≥3) predicts a poor prognosis in both overall survival and disease-free survival. Resection with free margins, described on the pathological results and defined in this work as R0, show better disease-free survival.     

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目的 探讨原发性腹膜后脂肪肉瘤复发、转移机理及预后。方法 复习原发性腹膜后脂肪肉瘤临床资料及文献，总结伴有亚型转化的原发性腹膜后脂肪肉瘤病人的生存时间及复发率。分析反复复发与远外转移的关系。结果 伴有亚型转化的病人平均复发次数高于非亚型转化病人，但生存时间较长。肿瘤复发可诱导去分化危险。结论 亚型转化使腹膜后脂肪肉瘤的复发次数增加而不影响生存期。肿瘤复发诱导去分化危险，肿瘤可获得转移的能力。     

The importance of the margin of resection and radiotherapy in retroperitoneal liposarcoma

BackgroundPrior studies evaluating the impact of adjuvant or neoadjuvant radiotherapy on clinical outcomes in retroperitoneal liposarcoma have been underpowered.MethodsWe queried the National Cancer Database for patients undergoing resection of retroperitoneal liposarcoma from 2004 to 2016. Cox proportional hazards modeling stratified by tumor size was used to identify factors associated with overall survival.Results4018 patients met inclusion criteria. 251 had small (<5 cm), 574 intermediate (5–10 cm), and 3193 large (>10 cm) tumors. Positive surgical margins were correlated with risk of death across all tumor size categories (<5 cm HR 2.33, CI [1.20, 4.55]; 5–10 cm HR 1.49, CI [1.03, 2.14]; >10 cm HR 1.30, CI [1.12, 1.51]). Adjuvant radiotherapy was associated with improved survival for patients with large tumors only (HR 0.75, CI [0.64, 0.89]).ConclusionsIn retroperitoneal liposarcoma, adjuvant radiation is associated with improved survival only for patients with tumors larger than 10 cm. Radiation should be used sparingly in patients with smaller tumors.SummaryThe use of radiotherapy in the management of retroperitoneal sarcoma remains controversial. We isolated retroperitoneal liposarcomas only and identified a survival benefit from radiotherapy treatment only in tumors larger than 10 cm and only in the adjuvant setting.