Aim. Analysis of the initial surgical approach in patients with localized RMS, enrolled in the Italian Studies from 1979 to 2002. Materials and Methods. Surgical records of 459 patients were reviewed (132 RMS-79, 215 RMS-88, 212 RMS-96). An initial excision was recommended, if microscopical complete, otherwise, biopsy was mandatory. Primary-Re-Excision (PRE) was introduced in 1990. Results. An initial biopsy was performed in 65/132 (49%) patients in the first study, 125/215 (58%) in the second, 121/212 (57%) in the third. A conservative excision was obtained in 65 (49%), 90 (42%), 91 (43%) patients respectively: complete 31/ 65¼46%, 29/90 (7after PRE)¼32%, 42/91(23 after PRE)¼46% respectively; with microscopical residual 16/65, 25/90, 34/91; with macroscopical residual 18/65, 36/90, 15/91. A mutilating excision was performed in 2 patients in RMS-79 (complete 1). Sites: most GUnBP sites were successfully excised: 74% in RMS-79, 76% in RMS-88, 85% in RMS-96. 10% of HNnPM/Others RMS underwent complete excision. A complete resection was rarely attempted in HNPM, Orbit, GUBP sites. The approach to Extremity has been changed: in RMS-79, 10/16 patients underwent a complete conservative excision, while most patients in the following studies were biopsied (9/14, 11/19 respectively). Size and T-status (RMS-96): 64/107 (60%) patients with tumor <5 cm and 27/105 (26%) with tumor >5 cm underwent primary resection, obtaining the completeness in 48% and 41% respectively. Resection was attempted in 63/99 (64%) T1 and 25/113 (22%) T2 tumors, achieving completeness in 31/63 (49%) and in 10/25(40%) respectively. Conclusions. A) The initial surgical approach has become more conservative, avoiding mutilations, but the incomplete resection rate is still high. B) PRE has increased the possibility of complete resections. C) A satisfactory initial excision was obtained in GUnBP RMS (mainly paratesticular). In other localizations the feasibility of a complete resection was slightly better for T1a RMS; a careful evaluation of operability is necessary also in these cases.

Initial surgery for localized rhabdomyosarcoma(RMS):lessons from the italian studies

CECCHETTO, GIOVANNI;BISOGNO, GIANNI;ZANON, GIOVANNI FRANCO;
2004

Abstract

Aim. Analysis of the initial surgical approach in patients with localized RMS, enrolled in the Italian Studies from 1979 to 2002. Materials and Methods. Surgical records of 459 patients were reviewed (132 RMS-79, 215 RMS-88, 212 RMS-96). An initial excision was recommended, if microscopical complete, otherwise, biopsy was mandatory. Primary-Re-Excision (PRE) was introduced in 1990. Results. An initial biopsy was performed in 65/132 (49%) patients in the first study, 125/215 (58%) in the second, 121/212 (57%) in the third. A conservative excision was obtained in 65 (49%), 90 (42%), 91 (43%) patients respectively: complete 31/ 65¼46%, 29/90 (7after PRE)¼32%, 42/91(23 after PRE)¼46% respectively; with microscopical residual 16/65, 25/90, 34/91; with macroscopical residual 18/65, 36/90, 15/91. A mutilating excision was performed in 2 patients in RMS-79 (complete 1). Sites: most GUnBP sites were successfully excised: 74% in RMS-79, 76% in RMS-88, 85% in RMS-96. 10% of HNnPM/Others RMS underwent complete excision. A complete resection was rarely attempted in HNPM, Orbit, GUBP sites. The approach to Extremity has been changed: in RMS-79, 10/16 patients underwent a complete conservative excision, while most patients in the following studies were biopsied (9/14, 11/19 respectively). Size and T-status (RMS-96): 64/107 (60%) patients with tumor <5 cm and 27/105 (26%) with tumor >5 cm underwent primary resection, obtaining the completeness in 48% and 41% respectively. Resection was attempted in 63/99 (64%) T1 and 25/113 (22%) T2 tumors, achieving completeness in 31/63 (49%) and in 10/25(40%) respectively. Conclusions. A) The initial surgical approach has become more conservative, avoiding mutilations, but the incomplete resection rate is still high. B) PRE has increased the possibility of complete resections. C) A satisfactory initial excision was obtained in GUnBP RMS (mainly paratesticular). In other localizations the feasibility of a complete resection was slightly better for T1a RMS; a careful evaluation of operability is necessary also in these cases.
2004
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/2472167
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