Marjinal rezeksiyon sonrası gelişen tek merkezli 31 elastofibroma dorsi vakalarında komplikasyonları etkileyen faktörler

Year 2023, , 139 - 144, 27.03.2023

Mesut Mısırlıoğlu , İzzet Bingöl , Hüseyin Çakmak , Hamit Göksu , Umut Baran Zengin , Bedii Şafak Güngör

https://doi.org/10.47582/jompac.1255207

Abstract

Amaç: Elastofibroma dorsi (ED), genellikle beşinci dekattan sonra kadınlarda subskapular bölgede nadir görülen, benign bir bağ dokusu tümörüdür. Tek merkezde cerrahi olarak tedavi edilen ED vakalarının klinik özelliklerini, yönetimini ve uzun dönem sonuçlarını sunmayı amaçladık.
Gereç ve Yöntem: Ocak 2010 ile Ocak 2021 tarihleri arasında histopatolojik olarak ED tanısı alan ve ortalama yaşları 56,6 olan 31 hastanın (7 erkek, 24 kadın) verileri hastane kayıtlarından retrospektif olarak incelendi. Ortalama takip süresi 80,2 (19-144) aydı. Dokuz vaka çift taraflıydı. Radyolojik ve klinik olarak tanı konulan tüm olgulara marjinal rezeksiyon cerrahisi uygulandı ve üç hastaya preoperatif biyopsi yapıldı. Sonuçlar takip sırasında ağrı için görsel analog skala (VAS) kullanılarak değerlendirildi.
Bulgular: Ameliyat sonrası erken dönemde toplam 11 hastada (%35) sonradan takiplerde düzelen şu kompliksayonlar gözlenmiştir; kronik ağrı (n=5), hematom (n=5), seroma (n=5), enfeksiyon (n=2). Bir hastada takip sürecinde görülen lokal nüks re-eksize edildi. Bilateral ED'li hastalarda (p=0,015), ağır işlerde ve el emeği ile yapılan işlerde çalışanlarda (p=0,013), ek hastalığı olanlarda (p=0,006), sırtüstü yatanlarda (p=0,031), ve senkronize cerrahi geçiren (p=0,013) hasta gruplarında istatistiksel olarak anlamlı daha fazla komplikasyonlar gözlenmiştir. Ayrıca longitudinal uzunluğu fazla olan kitlelerde (p=0,016), ameliyat öncesi semptom süresi uzun olanlarda (p=0,009) ve ameliyat süresi uzun hasta gruplarında, (p=0,025) istatistiksel olarak anlamlı derecede daha fazla komplikasyon gözlendi. Ortalama VAS skoru preoperatif 4,97'den, postoperatif 1,52'ye kadar istatistiksel olarak anlamlı derecede düzelme gösterdi (p<0,001).
Sonuç: Marjinal rezeksiyon sonrası uzun dönem takiplerde tatmin edici sonuçlar elde edilirken erken postoperatif dönemde birçok komplikasyonla karşılaşılır. Bu hastalarda semptomlar ve lezyonlar kapsamlı bir şekilde değerlendirildikten sonra rezeksiyon kararı verilmeli, hastalar komplikasyonlar konusunda bilgilendirilmeli ve titiz cerrahi sonrası takip süreleri uzatılmalıdır.

Keywords

Elastofibroma dorsi, marginal resection, subscapular mass, benign tumor

Factors affecting complications in 31 cases of elastofibroma dorsi after marginal resection in a single center

Abstract

Aim: Elastofibroma dorsi (ED) is an uncommon benign connective-tissue tumor, usually seen in the subscapular region of women after the fifth decade. We present the clinical features, management, and long-term outcomes of cases of ED treated surgically in a single institution.
Material and Method: The data of 31 patients (7 male, 24 female) with a histopathological diagnosis of ED between January 2010 and January 2021 and mean age of 56.6 years were reviewed retrospectively from their records. The mean follow-up duration was 80.2 (19-144) months. Nine cases were bilateral. Marginal resection surgery was performed in all cases diagnosed radiologically and clinically, and preoperative biopsies were performed for three patients. The results were evaluated using a visual analogue scale (VAS) for pain during follow-up.
Results: Complications such as chronic pain (n=5), hematoma (n=5), seroma (n=5), and infection (n=2) were seen in 11 patients (35%) in the early postoperative period and improved over the course of follow-up. A local recurrence observed in one patient during follow-up was re-excised. Significantly more complications were observed in patients with bilateral ED (p=0.015), manual laborers and heavy laborers (p=0.013), patients with comorbidities (p=0.006), those who slept in the supine position (p=0.031), and those who underwent synchronized surgery (p=0.013). In addition, statistically significantly more complications were observed in cases of masses with longer longitudinal length (p=0.016), patients with longer preoperative symptom duration (p=0.009), and longer operative times (p=0.025). The average VAS score improved significantly from 4.97 to 1.52 after surgery (p<0.001).
Conclusion: While satisfactory results were obtained over a long follow-up duration after marginal resection, many complications were encountered in the early postoperative period. The decision for resection should be made after a comprehensive evaluation of symptoms and lesions, patients should be informed about complications, and follow-up periods should be prolonged after meticulous surgery.

Keywords

Elastofibroma dorsi, marginal resection, subscapular mass, benign tumor

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