Indications of Microsurgery in Soft Tissue Sarcomas

Viñals, J.; Rodrigues, T.A. Gomes; Sildenikova, D. Perez; Payro, J.M. Serra; Porte, J; Suñe, C. Higueras; Ojeda, A. Lopez; Vidal, J; Dewever, Mike; López, Cristina M.; Segu, J. O. Bermejo; Chavarria, F. A.

doi:10.1055/s-0032-1326740

Cited by 20 publications

(6 citation statements)

References 27 publications

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“…Several authors have reported that local or regional flaps are associated with higher complication rates and have inferior functional results compared to free flaps ( 7 , 47 ), which is also our own experience. Some authors found that free-flap reconstruction after soft tissue sarcoma excision at the upper extremity is associated with increased morbidity but better local control ( 48 ).…”

Section: Reconstructionsupporting

confidence: 80%

Soft Tissue Sarcomas of the Arm – Oncosurgical and Reconstructive Principles within a Multimodal, Interdisciplinary Setting

2016

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Soft tissue sarcomas of the upper extremity represent a severe threat for the patient and a difficult task for the treatment team. Due to the complex anatomy of the arm, most sarcomas involve valuable functional structures. Nonetheless, a large portion of the patients can be treated in a limb-sparing manner, and surgery is the mainstay of local tumor control. This review gives an overview of the disease entities and their epidemiology, on necessary patient work-up, staging, and imaging modalities, as well as the importance of interdisciplinary decision-making. The surgical therapies and principles of tumor excision are outlined, as well as reconstructive options. Furthermore, adjuvant treatments are discussed with a special focus on the various application techniques for radiation therapy. In spite of established treatment algorithms, each case is an individual challenge and individually tailored therapy is required. This aspect is illustrated by presenting three comprehensive cases demonstrating useful strategies. A summary of the relevant literature is given.

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Section: Reconstructionsupporting

confidence: 80%

Soft Tissue Sarcomas of the Arm – Oncosurgical and Reconstructive Principles within a Multimodal, Interdisciplinary Setting

2016

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“…Nevertheless, complication rates between the reconstruction techniques were not significantly different between microsurgical free flaps, local/regional flaps or split skin grafts, but significantly higher compared to primary closure. It is known that microsurgical reconstruction after sarcoma surgery is reliable and safe [38,39], and many authors favor the use of microsurgical flaps over local options with regard to functional outcome and complication rates [6,27,38]. Complication rates themselves were in accordance with the literature [40].…”

Section: Discussionsupporting

confidence: 54%

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

Götzl

Sterzinger

Arkudas

et al. 2020

Cancers

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Background: Soft tissue sarcoma (STS) treatment is an interdisciplinary challenge. Along with radio(chemo)therapy, surgery plays the central role in STS treatment. Little is known about the impact of reconstructive surgery on STS, particularly whether reconstructive surgery enhances STS resection success with the usage of flaps. Here, we analyzed the 10-year experience at a university hospital’s Comprehensive Cancer Center, focusing on the role of reconstructive surgery. Methods: We performed a retrospective analysis of STS-patients over 10 years. We investigated patient demographics, diagnosis, surgical management, tissue/function reconstruction, complication rates, resection status, local recurrence and survival. Results: Analysis of 290 patients showed an association between clear surgical margin (R0) resections and higher-grade sarcoma in patients with free flaps. Major complications were lower with primary wound closure than with flaps. Comparison of reconstruction techniques showed no significant differences in complication rates. Wound healing was impaired in STS recurrence. The local recurrence risk was over two times higher with primary wound closure than with flaps. Conclusion: Defect reconstructions in STS are reliable and safe. Plastic surgeons should have a permanent place in interdisciplinary surgical STS treatment, with the full armamentarium of reconstruction methods.

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“…Still, applying plastic surgical principles facilitates limb preservation with the restoration of function even in large tumors. Thus, the utilization of microsurgical reconstruction in sarcoma defects represents a reliable and safe option (25, 26), and is favorable over local options in regards of complication rates and functional outcome (26, 27). By following oncosurgical principles, our results with low amputation rates resembled data published elsewhere (6).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Indications of Microsurgery in Soft Tissue Sarcomas

Cited by 20 publications

References 27 publications

Soft Tissue Sarcomas of the Arm – Oncosurgical and Reconstructive Principles within a Multimodal, Interdisciplinary Setting

Soft Tissue Sarcomas of the Arm – Oncosurgical and Reconstructive Principles within a Multimodal, Interdisciplinary Setting

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

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

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