Abstract
Management of extremity sarcoma has shifted from amputation to limb salvage surgery with improvements in surgical techniques and multimodality treatment protocols. For tumors involving major neurovascular bundles, it has not been accepted as a routine practice uniformly due to fear of oncological outcomes, postoperative morbidity, and lack of expertise in microvascular surgery. We analyzed our experience of limb salvage surgery with vascular reconstruction for extremity sarcomas. Retrospective analysis of patients with extremity sarcomas undergoing limb salvage surgery through vascular reconstruction was done. The feasibility, surgical, oncological, and functional outcomes of these patients was studied. Out of 176 patients undergoing limb preserving surgery for extremity sarcoma, limb salvage using vascular resection and reconstruction was done in 14 patients. Mean age of these 14 patients was 35.4 years (19–49). Arterial reconstruction was done in 7 patients, venous in 5, and in 2 patients both arterial and venous reconstructions were performed. All the 14 patients had tumor-free margins, and none had immediate post-operative graft failure requiring amputation. Post radiation graft exposure occurred in one patient. Involvement of major vascular bundle in extremity sarcomas should not always be considered a contraindication for limb preservation. Optimal oncological outcome with preserved limb function can be achieved by arteriovenous reconstructive procedures. In places with limited resources, autologous grafts are preferred because of constraints of availability and cost.
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References
Emori M, Hamada K, Omori S, Joyama S, Tomita Y, Hashimoto N, Takami H, Naka N, Yoshikawa H, Araki N (2012) Surgery with vascular reconstruction for soft-tissue sarcomas in the inguinal region: oncologic and functional outcomes. Ann Vasc Surg 26:693–699
Schwarzbach MH, Hormann Y, Hinz U, Bernd L, Willeke F, Mechtersheimer G, Böckler D, Schumacher H, Herfarth C, Büchler MW, Allenberg JR (2005) Results of limb sparing surgery with vascular replacement for soft tissue sarcoma in the lower extremity. J Vasc Surg 42:88–97
Deo SVS, Manjunath NML, Shukla NK (2012) A review of controversies in the management of soft tissue sarcomas. Indian J Surg 74(3):228–233
Rosenberg SA, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, DeMoss E, Seipp C, Sindelar WF, Sugarbaker P, Wesley R (1982) The treatment of soft-tissue sarcomas of the extremities prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 196(3):305–315
Muramatsu K, Ihara K, Miyoshi T, Yoshida K, Taguchi T (2011) Clinical outcome of limb salvage surgery after wide resection of sarcomas and femoral vessel reconstruction. Ann Vasc Surg 25:1070–1077
Fortner JG, Kim DK, Shiu MH (1977) Limb preserving vascular surgery for malignant tumors of the lower extremity. Arch Surg 112:391–394
Ramamurthy R, Soundrarajan JC, Mettupalayam V, Shanmugham S, Arumugam B, Periasamy S (2009) Limb conservation in extremity soft tissue sarcoma with vascular involvement. Indian J Orthop 43(4):403–407
McKay A, Motamedi M, Temple W, Mack L, Moore R (2007) Vascular reconstruction with superficial femoral vein following major oncologic resection. J Surg Oncol 96:151–159
Hohenberger P, Allenberg JR, Schlag PM, Reichardt P (1999) Results of surgery and multimodal therapy for patients with soft tissue sarcoma invading to vascular structures. Cancer 85:396–408
Ghert MA, Davis AM, Griffin AM, Alyami AH, White L, Kandel RA, Ferguson P, O'Sullivan B, Catton CN, Lindsay T, Rubin B, Bell RS, Wunder JS (2005) The surgical and functional outcomes of limb salvage surgery with vascular reconstruction for soft tissue sarcoma of the extremity. Ann Surg Oncol 12:1102–1110
Koperna T, Teleky B, Vogl S et al (1996) Vascular reconstruction for limb salvage in sarcoma of the lower extremity. Arch Surg 131:1103–1107
Matsushita M, Kuzuya A, Mano N, Nishikimi N, Sakurai T, Nimura Y, Sugiura H (2001) Sequelae after limb-sparing surgery with major vascular resection for tumor of the lower extremity. J Vasc Surg 33:694–699
Tsukushi S, Nishida Y, Sugiura H et al (2008) Results of limb salvage surgery with vascular reconstruction for soft tissue sarcoma in the lower extremity: comparison between only arterial and arteriovenous reconstruction. J Surg Oncol 97:216–222
Nishinari K, Krutman M, Aguiar Junior S, Pignataro BS, Yazbek G, Zottele Bomfim GA, Teivelis MP, Wolosker N (2015) Surgical outcomes of vascular reconstruction in soft tissue sarcomas of the lower extremities. J Vasc Surg 62:143–149
Kawai A, Hashizume H, Inoue H et al (1996) Vascular reconstruction in limb salvage operations for soft tissue tumors of the extremities. Clin Orthop Relat Res 332:215–222
Willard WC, Collin C, Casper ES et al (1992) The changing role of amputation for soft tissue sarcoma of the extremity in adults. Surg Gynecol Obstet 175:389–396
Davis LA, Dandachli F, Turcotte R, Steinmetz OK (2017) Limb-sparing surgery with vascular reconstruction for malignant lower extremity soft tissue sarcoma. J Vasc Surg 65:151–156
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Kumar, S., Manjunath, N.M.L., Manoj Gowda, S. et al. Limb Preservation Using Vascular Reconstruction in Patients with Large Extremity Soft Tissue Sarcomas: Results of Multi-Modality Therapy. Indian J Surg 82, 1088–1093 (2020). https://doi.org/10.1007/s12262-020-02161-7
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DOI: https://doi.org/10.1007/s12262-020-02161-7