Abstract
Bone and soft tissue sarcomas of lower and upper extremities may sometimes be in close contact with neurovascular structures. In such cases, it is controversial that whether en bloc resection and vascular reconstruction to reach wider surgical margins or planned marginal resection with the help of adjuvant therapies should be preferred. This study aimed to determine surgical and oncological outcomes of planned marginal and wide resection of extremity sarcomas that are associated with major vascular structures in the extremities. The collected database of 54 patients treated by the same orthopedic and vascular surgeon for primary or locally recurrent soft and bone tissue sarcoma of extremities was retrospectively reviewed. Eligible subjects for this study were patients diagnosed with upper and lower extremity soft and bone tissue sarcomas that encased a maximum of 50% of the circumference of the major vascular structures, requiring limb-sparing resection. When microscopic positive (19 patients, 33.9%) and negative cases’ (35 patients, 66.1%) surgical margins were compared, local recurrence, metastasis, amputation, and tumor type (soft/bone) parameters showed no statistically significant difference. When metastatic and non-metastatic patients were compared, it was shown that bone tumors metastasized more than soft tissue tumors (p = 0.001). However, there was no difference between metastasis and amputation, histopathology, grade, nerve involvement, surgical margins, or local recurrences. The mean survival was 1460.6 ± 137.4 days, and the 6-year mortality was 87.5%. Anesthetic and surgical complication rates may be higher since en bloc resection surgeries of large tumors with vascular reconstructions take a very long time. Therefore, we suggest marginal resection with sub-adventitial dissection in those locations and wide resection at other areas according to the surgeon’s experiences about safe margin with the contribution of radiotherapy.
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References
Hueman MT, Thornton K, Herman JM et al (2008) Management of extremity soft tissue sarcomas. Surg Clin North Am 88(3):539–557. https://doi.org/10.1016/j.suc.2008.04.003
Khatri VP, Goodnight JE (2005) Extremity soft tissue sarcoma: controversial management issues. Surg Oncol 14(1):1–9. https://doi.org/10.1016/j.suronc.2004.07.002
Mavrogenis AF, Coll-Mesa L, Gonzales-Gaitano M et al (2011) Criteria and outcome of limb salvage surgery. J BUON 16(4):617–626
Chao AH, Mayerson JL, Chandawarkar R et al (2015) Surgical management of soft tissue sarcomas: extremity sarcomas. J Surg Oncol 111(5):540–545. https://doi.org/10.1002/jso.23810
Ozturk R, Aydın M, Arıkan ŞM et al (2018) Extremity soft tissue sarcomas of uncertain differentiation: presentation, treatment, and outcomes in a clinical series of 59 patients. Bakırköy Tıp Dergisi 14:31–9. https://doi.org/10.5350/BTDMJB.20161217033551
McKee MD, Liu DF, Brooks JJ et al (2004) The prognostic significance of margin width for extremity and trunk sarcoma. J Surg Oncol 85(2):68–76. https://doi.org/10.1002/jso.20009
DiCaprio MR, Friedlaender GE (2003) Malignant bone tumors: limb-sparing versus amputation. J Am Acad Orthop Surg 11(1):25–37
Veth R, Van Hoesel R, Pruszczynski M et al (2003) Limb salvage in musculoskeletal oncology. Lancet Oncol 4(6):343–350. https://doi.org/10.1016/S1470-2045(03)01114-8
Kandel R, Coakley N, Werier J et al (2013) Surgical margins and handling of soft-tissue sarcoma in extremities: a clinical practice guidline. Curr Oncol 20(3):e247–e254. https://doi.org/10.3747/co.20.1308
Panicek DM, Go SD, Healey JH et al (1997) Soft-tissue sarcoma involving bone or neurovascular structures: MR imaging prognostic factors. Radiology 205:871–875
Ramamurthy R, Soundrarajan JC, Mettupalayam V et al (2009) Limb conservation in extremity soft tissue sarcomas with vascular involvement. Indian J Orthop 43(4):403–407. https://doi.org/10.4103/0019-5413.54969
Schwarzbach MH, Horman Y, Hinz U et al (2005) Results of limb-sparing surgery with vascular replacement of soft tissue sarcoma in the lower extremity. J Vasc Surg 42(1):88–97. https://doi.org/10.1016/j.jvs.2005.03.017
Ghert MA, Davis AM, Griffin AM et al (2005) The surgical and functional outcome of limb-salvage surgery with vascular reconstruction for soft tissue sarcoma of the extremity. Ann Surg Oncol 12(12):1102–1110. https://doi.org/10.1245/ASO.2005.06.036
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(3):216–20. https://doi.org/10.1002/jso.20945
Bonardelli S, Nadari F, Maffies R et al (2000) Limb salvage in lower-extremity sarcomas and technical details about vascular reconstruction. J Orthop Sci 5(6):555–560
Feydy A, Anract P, Tomeno B et al (2006) Assessment of vascular invasion by musculoskeletal tumors of the limbs: use of contrast-enhanced MR Angiography. Radiology 238(2):611–621. https://doi.org/10.1148/radiol.2382041725
Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120
Öztürk R, Arıkan ŞM, Bulut EK et al (2019) Distribution and evaluation of bone and soft tissue tumors operated in a tertiary care center. Acta Orthop Traumatol Turc. https://doi.org/10.1016/j.aott.2019.03.008
McKay A, Motamedi M, Temple W et al (2007) Vascular reconstruction with the superficial femoral vein following oncologic resection. J Surg Oncol 96(2):151–159. https://doi.org/10.1002/jso.20788
Matsushita M, Kuzuya A, Mano N et al (2001) Sequelae after limb-sparing surgery with major vascular resection for tumor of the lower extremity. J Vasc Surg 33(4):694–699. https://doi.org/10.1067/mva.2001.112799
Hao Y, Yang C, He J (2018) The accurate surgical margin before surgery for malignant musculoskeletal tumors: a retrospective study. Am J Transl Res 10(8):2324–2334
Adelani MA, Holt GE, Dittus RS et al (2007) Revascularization after segmental resection of lower extremity soft tissue sarcomas. J Surg Oncol 95(6):455–460. https://doi.org/10.1002/jso.20679
Fritz J, Fishman EK, Corl F et al (2012) Imaging of limb salvage surgery. Am J Roentgenol 198(3):647–660. https://doi.org/10.2214/AJR.11.7286
Bell RS, O’Sullivan B, Liu FF (1989) The surgical margin in soft tissue sarcoma. J Bone Joint Surg Am 71:370–375
Stojadinovic A, Leung DH, Hoos A et al (2002) Analysis of the prognostic significance of microscopic margins in 2,084 localized primary adult soft tissue sarcomas. Ann Surg 235:424–434
Trovik CS, Bauer HC, Alvegard TA et al (2000) Surgical margins, local recurrence and metastasis in soft tissue sarcomas: 559 Surgically- treated patients from the Scandinavian Sarcoma Group Register. Eur J Cancer 36:710–716
Cardona K, Movva S (2013) Issues in the management of high-risk localized sarcomas. Curr Probl Cancer 37(2):62–73
Alektiar KM, Leung D, Zelefsky MJ et al (2002) Adjuvant radiation for Stage II-B soft tissue sarcoma of the extremity. J Clin Oncol 20:1643–1650
Suit HD, Mankin HJ, Wood WC et al (1985) Preoperative, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma. Cancer 55:2659–67
LeVay J, O’Sullivan B, Catton C et al (1993) Outcome and prognostic factors in soft tissue sarcoma in the adult. Int J Radiat Oncol Biol Phys 27:1091–9
Corinne Sadoski Herman, D., Suit Andrew, Rosenberg Henry, Mankin Jimmy, Efird, (1993) Preoperative radiation surgical margins and local control of extremity sarcomas of soft tissues. J Surg Oncol 52(4):223–230. https://doi.org/10.1002/jso.2930520405
Roi Dagan Daniel, J., Indelicato Lisa, McGee Christopher G., Morris Jessica M., Kirwan Jacquelyn, Knapik John, Reith Mark T., Scarborough C. Parker, Gibbs Robert B., Marcus Robert A., Zlotecki, (2012) The significance of a marginal excision after preoperative radiation therapy for soft tissue sarcoma of the extremity. Cancer 118(12):3199–3207. https://doi.org/10.1002/cncr.26489
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AFK, İG, and RÖ made the study design. İG and RÖ made the data collection and interpretation. AFK, İG, RÖ, and BŞG made manuscript writing. AFK, İG, RÖ, and BŞG did the final approval of the manuscript. All authors read and approved the final manuscript.
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Kekeç, A.F., Günaydın, İ., Öztürk, R. et al. Outcomes of Planned Marginal and Wide Resection of Sarcomas Associated with Major Vascular Structures in Extremities. Indian J Surg Oncol 13, 395–402 (2022). https://doi.org/10.1007/s13193-021-01476-5
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DOI: https://doi.org/10.1007/s13193-021-01476-5