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Der Orthopäde

, Volume 48, Issue 9, pp 768–775 | Cite as

Resektionsgrenzen bei Weichteilsarkomen

  • B. RathEmail author
  • J. Hardes
  • M. Tingart
  • T. Braunschweig
  • J. Eschweiler
  • F. Migliorini
Leitthema

Zusammenfassung

Hintergrund

Weichteilsarkome (WTS) sind eine seltene und heterogene Gruppe von bösartigen Tumoren, die aus dem mesenchymalen Gewebe entstehen. Weichteilsarkome können sich überall im menschlichen Körper bilden, wobei die Extremitäten bevorzugte Prädilektionsstellen sind.

Therapie

Einen grundlegenden Pfeiler der Therapie stellt die chirurgische Resektion des Weichteilsarkoms dar. Angestrebt wird immer eine R0-Resektion mit einem Sicherheitsabstand. In der Literatur gibt es keinen einheitlichen Konsens über den anzustrebenden tumorfreien Resektionsrand. Entscheidende Faktoren für diese Resektionsgrenzen sind die Histopathologie, das Vorhandensein von anatomischen Barrieren (Kapsel, Sehne, Faszie, Knorpel, Periost) und die Möglichkeiten einer (neo-)adjuvanten Therapie.

Diskussion

Hinweise in der Literatur stützen die Rolle der Resektionsränder als Prädiktor für ein lokales Rezidiv. In Bezug auf die Rolle der Resektionsränder für die Gesamtüberlebensrate sind die Literaturangaben divergent. Es gibt bekannte Prognosefaktoren, die das Gesamtüberleben beeinflussen, wie den histologischen Subtyp, die Tumorgröße, das Tumorgrading und das Vorhandensein von Metastasen. Bisher haben mehrere Studien versucht, die Resektionsränder zu quantifizieren, es wurde jedoch kein Konsens erzielt und die Debatten dauern an. Bei der Analyse aller Ergebnisse der Daten in der Literatur scheint es angebracht zu sein, negative Resektionsränder >1 mm und, falls möglich, unter Einbeziehung einer anatomischen Barriere anzustreben.

Schlüsselwörter

Extremitäten Faszien Lokalrezidiv Prognostische Faktoren Tumorgrading 

Abkürzungen

AJCC

American Joint Committee on Cancer

ALT

Atypischer lipomatöser Tumor

TNM

Tumor, Nodus, Metastasen

UICC

„Union internationale contre le cancer“

WHO

World Health Organization

WTS

Weichteilsarkome

Resection margins in soft tissue sarcomas

Abstract

Background

Soft tissue sarcomas (STS) are a rare and heterogeneous group of malignant tumors that arise from the mesenchymal tissue. STS can form anywhere in the human body, with the extremities being preferred sites of predilection.

Treatment

A fundamental pillar of treatment is the surgical resection of soft tissue sarcomas. The goal is always an R0 resection with a safety margin. There is no consensus in the literature about the desired tumor-free resection margin. The decisive factors for these resection margins are histopathology, presence of anatomical barriers (capsule, tendon, fascia, cartilage, periosteum) and possibilities of (neo-) adjuvant therapy.

Discussion

References in the literature support the role of resection margins as a predictor of local recurrence. Regarding the role of resection margins in overall survival, available data is divergent. There are known prognostic factors that influence overall survival, such as histological subtype, tumor size, tumor grading, and presence of metastases. So far, several studies have attempted to quantify the margins of resection, but no consensus has been reached, and debates are ongoing. When analyzing all the results of the data in the literature, it seems appropriate to aim for a negative resection margin >1 mm including an anatomical border structure, if possible.

Keywords

Extremities Fascia Local neoplasm recurrences Prognostic factors Tumor grading 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

B. Rath, M. Tingart, T. Braunschweig, J. Eschweiler und F. Migliorini geben an, dass kein Interessenkonflikt besteht. J. Hardes erhält eine Forschungsförderung von der Firma Implantcast.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • B. Rath
    • 1
    Email author
  • J. Hardes
    • 2
  • M. Tingart
    • 1
  • T. Braunschweig
    • 3
  • J. Eschweiler
    • 1
  • F. Migliorini
    • 1
  1. 1.Klinik für OrthopädieUniklinik RWTH AachenAachenDeutschland
  2. 2.Abteilung für Tumororthopädie und SarkomchirurgieWestdeutsches Tumorzentrum, Universitätsklinikum EssenEssenDeutschland
  3. 3.Institut für PathologieUniklinik RWTH AachenAachenDeutschland

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