Efficacy and Safety of Microsurgery in Interdisciplinary Treatment of Sarcoma Affecting the Bone

Abstract

Background: Sarcomas are tumors of mesenchymal origin with high variation in anatomical localization. Sarcomas affecting the bone often require an interdisciplinary resection and reconstruction approach. However, it is critical that microsurgical reconstruction strategies do not negatively impact tumor safety and overall survival, as limb salvage is only the secondary goal of tumor surgery. Here, we analyzed the efficacy and safety of microsurgery in interdisciplinary treatment of sarcoma affecting the bone.Patients and Methods: We performed a retrospective chart review of all patients treated for soft-tissue and bone sarcoma at the senior author's institution with a focus on bone affection and microsurgical reconstruction between 2000 and 2019. This particular subgroup was further investigated for tumor resection status, 5-year survival rate, length of hospital stay, as well as overall complication and amputation rates.Results: Between 2000 and 2019, 803 patients were operated for sarcoma resection and reconstruction by the Department of Plastic and Hand Surgery. Of these, 212 patients presented with sarcoma of the extremity affecting the bone. Within this subgroup, 40 patients required microsurgical reconstruction for limb salvage, which was possible in 38 cases. R0 resection was achieved in 93.8%. The 5-year survival was 96.7%, and the overall complication rate was 25%, of which 40% were microsurgery associated complications.Conclusion: Safe and function-preserving treatment of soft-tissue and bone sarcoma is challenging. Primary reconstruction with microsurgical techniques of sarcoma-related defects enables limb-sparing and adequate oncosurgical cancer treatment without increasing the risk for local recurrence or prolonged hospital stay. The treatment of sarcoma patients should be reserved to high-volume centers with experienced plastic surgeon embedded in a comprehensive treatment concept.

The Role of Plastic Reconstructive Surgery in Surgical Therapy of Soft Tissue Sarcomas

“…Tissue reconstruction in STS, a classical domain of reconstructive surgery, can restore tissue, repair critical-size resection defects to cover crucial structures, restore function and salvage limbs [4,5]. Although limb salvage is only a secondary goal of tumor surgery, reconstructive surgery plays an essential role in sarcoma treatment because of the potential reconstructive benefits, while at the same time not adversely impacting tumor safety, survival or complication rates [6,7].…”

Efficacy and Cost-Benefit Analysis of Magnetic Resonance Imaging in the Follow-Up of Soft Tissue Sarcomas of the Extremities and Trunk

“…e sequence of treatment modalities was proposed by the interdisciplinary sarcoma board, and plastic surgeons specialized in sarcoma surgery performed the oncological resection and reconstruction. Our approach to treatment and surgical strategy was extensively published previously [1,6,8,[16][17][18][19][20][21]. is study analysed local recurrence and not distant metastases.…”

Wirtschaftliche Aspekte in der Mikrochirurgie: Bericht zum Konsensus-Workshop der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße – (DAM)

“…Bei der rekonstruktiven Tumorchirurgie haben sich mikrochirurgische Eingriffe nach ausgedehnten Resektionen als funktionell überlegen, onkologisch sicher und wirtschaftlich zweckmäßig gezeigt. Hierzu liegen sowohl Daten zu Eingriffen bei Kopf-Hals-Tumoren mit aufwändigen mikrochirurgischen Rekonstruktionen als auch zum Extremitätenerhalt bei Sarkomen vor [10][11][12]. Darüber hinaus existieren Bereiche, wie die dynamische Gesichtsreanimation mit freien Muskeltransplantation bei lange bestehender Fazialisparese, welche zu einer deutlichen Verbesserung der Lebensqualität der Betroffenen führt [13].…”