Limb conservation in extremity soft tissue sarcomas with vascular involvement

Abstract

Background:The major neurovascular involvement and large primary tumors are indication of amputation. The present study is an attempt to explore the feasibility of a limb salvage surgery in extremity sarcoma cases with major vessel involvement. Oncological outcomes and surgery-related morbidities are compared with those reported in literature.Materials and Methods:A retrospective review of all limb salvage surgeries done in our department between 2005 and 2008 was done and four cases of extremity sarcoma of lower limb involving femoral vessels analyzed. Interpretation of data from these cases, along with review of literature, is done.Results:In all these cases a wide monobloc excision was done adhering to oncological principles. This required resection of superficial femoral artery alone in two cases, resection of superficial femoral artery along with common femoral vein and femoral nerve in another, and of common femoral vein alone in yet another. Reconstruction was done in all these cases with reversed long saphenous vein graft. Histopathology of resected margins was free of tumor in all the four patients. One patient developed local recurrence and one developed distant metastsis. Two were disease free for one year with good functional limb, one has been disease-free for three years and another was disease-free at two years, after which he defaulted further follow-up. One patient developed arterial blowout which required ligation of common femoral artery which resulted in gangrene of the limb. He underwent amputation.Conclusion:Major neurovascular involvement in extremity sarcoma is not considered a contraindication for limb salvage surgery. Review of literature also supports our view. Post-operative wound related complications are more in this group of patients. However, long term functional outcome is good. Literature suggests a good long term local control after vascular resection and reconstruction.

Management of solitary fibrous tumors localized in extremity: case series and a review of the literature

“…[1,5,11,12,19,20] In malignant tumors, common indications for amputation are major neurovascular involvement and large primary tumor where resection would leave a functionally useless limb. [21] In our study, there were involvements of femoral artery-vein in case 5 and of medial collateral ligament in case 7. There was low malignancy risk for both cases according to risk stratification model.…”

Outcomes of Vascular Resection and Reconstruction in Extremity Soft Tissue Sarcoma and Bone Tumors

“…Thus, en bloc resection is the mainstay of treatment for sarcomas involving blood vessels, to achieve negative margins and reduce local recurrence. Many studies have reported local recurrence rates of 14% to 47% [ 1 , 5 , 19 ]. Fortunately, there were no local recurrences in the present study.…”

Sarcoma of the Thigh: Radical Excision with Arterial Reconstruction Using the Contralateral Saphenous Vein

“…2 The femoral artery is commonly replaced with an autologus reversed saphenous vein graft because of its resistance to infections and its excellent patency rates 2-4 compared with artificial grafts. 4,5 We present a case of thigh sarcoma involving the femoral vascular axis with complete clogging of the femoral vein due to massive deep thrombosis. The video illustrates the features of the case and highlights the steps of a wide compartment resection with arterial reconstruction by autologus reversed saphenous vein graft.…”