Limb-sparing surgery with vascular reconstruction for extremity soft tissue sarcomas: surgical, oncological and functional outcomes.

BACKGROUND

The indications of limb-sparing surgery (LSS) for extremity soft tissue sarcoma (ESTS) can be extended by excision with simultaneous reconstruction of major blood vessels without adding significant risk.

METHODS

From January 2005 to January 2009, 12 patients with (ESTS) underwent LSS with major vascular reconstruction. Patients with metastatic disease and those with cardiopulmonary restraints were excluded. Arterial repair was mandatory whilst venous repair was selective according to selected protocol. Data were collected regarding the method of treatment, complications and tumor recurrence.

RESULTS

All tumors could be resected without amputation. In spite of the large tumor size 10 (83.3 %) patients were resected with negative margins. Vascular complications occurred in eight patients: 4 cases of DVT, edema in 3 patients and one patient developed secondary hemorrhage that ended up by limb amputation. Nonvascular complications occurred in nine patients: Partial necrosis of the flap (n =2), wound infection (n =3), Wound dehiscence (n =2) hematoma (n =1) and seroma (n =1). The 2-year overall survival rates were 53.9 %. Cumulative local recurrence free survival was 64.2 %. Cumulative distant metastasis-free survival was 58.3 %. Survival was significantly longer for surgical margin > 10mm (p < 0.027). During a median follow-up period of 20 months, 4 (33.3 %) developed local recurrence and 6 (50 %) developed Distant metastases.

CONCLUSIONS

Limb-sparing surgery with vascular reconstruction for extremity soft tissue sarcomas achieves good local control and functional results in the majority of extremity sarcomas for which amputation is infrequently indicated.

KEY WORDS: Extremity Ssarcoma - Limb - Sparing surgery - Vascular reconstruction.