7.P.16 THE SELECTION OF SURGICAL INTERVENTION VOLUME IN LOCAL SPREAD TUMORS OF SHOULDER GIRDLE

Abstract

We observed the 55 patients with local spread tumours of bones and soft tissues of shoulder girdle. There were 43 (78,2%) men, 12 (21,8%) women; the average age was 38,8. In 23 patients the tumour became localized into proximal part of humerus, 2 were in lateral end of clavicle, 4 were in shoulder blade, 18 were in soft tissues of upper two thirds of shoulder, 4 were in soft tissues of axiila, 3 were in soft tissues of shoulder blade and 1 was metastases of sarcoma of forearm soft tissues in armpit lymph nodes. In 8 cases the bone tumours were presented with osteosarcoma, 12 – hondrosarcoma, 5 – malignant giant celled tumour, 1 – Ewing’s sarcoma, 1 – reticulosarcoma, 2 – fibrosarcoma of bone. Among tumours of soft tissues, the fibrosarcoma and synovial sarcoma prevailed over 10 and 8.

Regard for local spread of tumour and degree of anatomical structures drawing in process, 47 patients performed interscapulothoracic amputation and 8 were interscapulothoracic resection (Tikhoff-Linberg operation). In pre- and post operative period the chemical and/or radiotherapy were performed in 43 patients. Selection the scheme and regimen of treatment depended on histological type of tumour.

The dates of observation were from 6 month to 14 years. The acute disorder of cerebral blood circulation was developed in one patient after interscapulothoracic amputation in early postoperative period. The local recurrence of tumour was revealed in 4 patients (8,4%) after interscapulothoracic amputation and in 3 patients (37,5%) after interscapulothoracic resection, in 14 (29,7%) and 4 (50%) were metastases conditionally. All patients had local recurrence in soft tissues. In 2 patients with local recurrence the amputation of extremities were performed.

There fore, the interscapulothoracic resection is used in local spread tumours of proximal part of humerus, shoulder blade, acromical part of clavicle and soft tissues of shoulder girdle, with some anatomical structures involved in process, but without affection of vascular-nerve fascicules. Involving in tumor process vascular and nerve plexus are statement for performing interscapulothoracic amputation.