Limb-Sparing Surgery for Extremity Sarcomas: Outcomes and Functional Analysis in a Six-Year Experience
Notice bibliographique
Résumé
There are approximately 8300 cases of sarcomas annually, with 50% occurring in the extremities. Currently, limb-sparing surgery is preferred over limb amputation. Extremity sarcomas at the authors' institution undergo limb-sparing surgery, when possible, with wide margin resection, immediate soft-tissue reconstruction, and adjuvant therapy. This report was a retrospective outcomes study and functional analysis of these patients over 6 years. Between February, 1998 and May, 2004 (75 months), 112 patients (72 males and 40 females, with ages 52.5 years ± 18.5 years) underwent salvage of 115 limbs (75 lower, 40 upper extremities). The thigh was the most common location (n = 44); 66% of the tumors were high-grade (n = 74); and 37.5% were MFH (n = 35). The average tumor size at resection was 6.8 ± 5.5 cm. The rectus abdominis, latissimus dorsi, gastrocnemius, and fasciocutaensou flaps accounted for 81.4% of the flaps used. Resection took 3.4 ± 1.7 hr, and reconstruction took 4.3 ± 2.1 hr. Ninety-five patients had neoadjuvant therapy, with 55 receiving pre- and 77 receiving postoperative therapy. Twenty-nine patients had both pre- and postoperative treatments. Brachytherapy (n = 26) was started on postoperative day 7.0 ± 1.5. Follow-up has been from 1 to 69 months with 10 patients lost to follow-up and 16 deaths. Twenty-seven developed metastasis, the most common location being the lung (n = 21). Of the 122 flaps, 42 were free with two acute losses (5%) and 4 late losses (10%). All pedicle flaps survived (overall flap survival: 95.1%). Fifty-six patients (50%) had minor or major wound complications, most commonly seromas. One patient (1%) required an above-knee amputation because of refractory periprosthetic infections. Postoperative function was analyzed with the Toronto Extremity Salvage Score. Of the 103 patients with at least 6 months recovery, 83 were known to be alive and 53 (64%) completed the survey at a mean of 27.6 months post surgery. The mean TESS was 83.2 (UE = 89.3; LE = 79.2, ns), indicating slight disability in daily activities (100 = no difficulty; 75 = slight difficulty). Patients' self-rated disability score was 4.3 (no disability = 5; slight = 4). Patients who had three different modalities of adjuvant therapy were more likely than those with only one modality to have a lower TESS, although not significantly (p = 0.057). There was no significance in TESS with respect to age, sex, adjuvant therapy, or type of adjuvant therapy). This study showed that even with major surgery, patients noted only limited disability. Despite a high rate of minor wound complications, limb-preservation surgery maintains the patient's ability to achieve a high level of functionality.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».