Journal of Korean Medical Science

Korean Acad Medical Sciences (대한의학회)
권호 표지
DOI QR코드

DOI QR Code

Outcomes after Arterial or Venous Reconstructions in Limb Salvage Surgery for Extremity Soft Tissue Sarcoma

  • Park, Daedo (Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine) ;
  • Cho, Sungsin (Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine) ;
  • Han, Ahram (Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine) ;
  • Choi, Chanjoong (Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine) ;
  • Ahn, Sanghyun (Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine) ;
  • Min, Sang-il (Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine) ;
  • Ha, Jongwon (Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine) ;
  • Min, Seung-Kee (Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine)
  • Received : 2018.03.11
  • Accepted : 2018.06.04
  • Published : 2018.10.01
⟨ Previous Next ⟩

Abstract

Background: Limb salvage surgery with vascular reconstruction is currently considered as the standard treatment for extremity soft tissue sarcoma (STS), showing equivalent oncologic outcome compared with amputation. In this retrospective study, the surgical and functional outcomes after arterial or venous reconstruction in limb salvage surgery for STS were analyzed. Methods: Consecutive patients who underwent vascular resection and reconstruction as part of limb salvage surgery for extremity STS from July 2009 to June 2015 were included in this study. Incidence of surgical complication, graft patency, and patients' functional outcome were reviewed. Results: During the study period, 14 arteries and 13 veins were reconstructed in 17 patients (artery only in 4, vein only in 3, artery and vein in 10). Autologous great saphenous vein (GSV) was the most commonly used vascular conduit in both arterial and venous reconstruction (78.6% and 77.0%). The patency of synthetic graft was significantly lower than that of the autologous vein conduit (log rank test, P = 0.001). Among 15 patients with tumors in lower extremity, 13 were ambulatory after limb salvage surgery. During median follow up of 23.3 months (interquartile range 39.9 months), 2 patients (11.7%) needed amputation of the initially salvaged limb due to local recurrence. Conclusion: Limb salvage surgery of soft tissue tumor combined with vascular reconstruction showed favorable functional outcome with good local control. Autologous vein conduit is preferred over synthetic graft both in arterial and venous reconstruction.

Keywords

References

  1. Lawrence W Jr. Concepts in limb-sparing treatment of adult soft tissue sarcomas. Semin Surg Oncol 1988;4(1):73-7. https://doi.org/10.1002/ssu.2980040114
  2. Schwarzbach MH, Hormann Y, Hinz U, Bernd L, Willeke F, Mechtersheimer G, et al. Results of limb-sparing surgery with vascular replacement for soft tissue sarcoma in the lower extremity. J Vasc Surg 2005;42(1):88-97. https://doi.org/10.1016/j.jvs.2005.03.017
  3. Nagarajan R, Neglia JP, Clohisy DR, Robison LL. Limb salvage and amputation in survivors of pediatric lower-extremity bone tumors: what are the long-term implications? J Clin Oncol 2002;20(22):4493-501. https://doi.org/10.1200/JCO.2002.09.006
  4. Williard WC, Hajdu SI, Casper ES, Brennan MF. Comparison of amputation with limb-sparing operations for adult soft tissue sarcoma of the extremity. Ann Surg 1992;215(3):269-75. https://doi.org/10.1097/00000658-199203000-00012
  5. Karakousis CP, Proimakis C, Walsh DL. Primary soft tissue sarcoma of the extremities in adults. Br J Surg 1995;82(9):1208-12. https://doi.org/10.1002/bjs.1800820919
  6. Karakousis CP, Emrich LJ, Rao U, Krishnamsetty RM. Feasibility of limb salvage and survival in soft tissue sarcomas. Cancer 1986;57(3):484-91. https://doi.org/10.1002/1097-0142(19860201)57:3<484::AID-CNCR2820570314>3.0.CO;2-K
  7. Fortner JG, Kim DK, Shiu MH. Limb-preserving vascular surgery for malignant tumors of the lower extremity. Arch Surg 1977;112(4):391-4. https://doi.org/10.1001/archsurg.1977.01370040043007
  8. Abbas JS, Holyoke ED, Moore R, Karakousis CP. The surgical treatment and outcome of soft-tissue sarcoma. Arch Surg 1981;116(6):765-9. https://doi.org/10.1001/archsurg.1981.01380180025006
  9. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980;(153):106-20.
  10. Mason GE, Aung L, Gall S, Meyers PA, Butler R, Krug S, et al. Quality of life following amputation or limb preservation in patients with lower extremity bone sarcoma. Front Oncol 2013;3(3):210.
  11. Nishinari K, Krutman M, Aguiar Junior S, Pignataro BS, Yazbek G, Zottele Bomfim GA, et al. Surgical outcomes of vascular reconstruction in soft tissue sarcomas of the lower extremities. J Vasc Surg 2015;62(1):143-9. https://doi.org/10.1016/j.jvs.2015.02.004
  12. Bonardelli S, Nodari F, Maffeis R, Ippolito V, Saccalani M, Lussardi L, et al. Limb salvage in lower-extremity sarcomas and technical details about vascular reconstruction. J Orthop Sci 2000;5(6):555-60. https://doi.org/10.1007/s007760070005
  13. Tsukushi S, Nishida Y, Sugiura H, Nakashima H, Ishiguro N. Results of limb-salvage surgery with vascular reconstruction for soft tissue sarcoma in the lower extremity: comparison between only arterial and arterovenous reconstruction. J Surg Oncol 2008;97(3):216-20. https://doi.org/10.1002/jso.20945
  14. Davis LA, Dandachli F, Turcotte R, Steinmetz OK. Limb-sparing surgery with vascular reconstruction for malignant lower extremity soft tissue sarcoma. J Vasc Surg 2017;65(1):151-6. https://doi.org/10.1016/j.jvs.2016.05.094

Cited by

  1. Oncovascular Surgery: Essential Roles of Vascular Surgeons in Cancer Surgery vol.35, pp.2, 2018, https://doi.org/10.5758/vsi.2019.35.2.60
  2. Vascular reconstruction using autologous vs synthetic graft for patients with extremity soft‐tissue sarcoma involving the major vessels vol.121, pp.2, 2020, https://doi.org/10.1002/jso.25775
  3. The Orthopedic-Vascular Multidisciplinary Approach Improves Patient Safety in Surgery for Musculoskeletal Tumors: A Large-Volume Center Experience vol.11, pp.6, 2018, https://doi.org/10.3390/jpm11060462