Strategy to preserve function in lower limbs tumors resection. Vascular competence in multidisciplinary approach

Abstract

IntroductionAll possible strategy should be adopted to preserve limb function during the definitive removal operation in the case of limbs sarcoma. Multidisciplinary perspective seems to be the ideal choice. The aim of the study is to report our experience gained in collaboration with the IFO oncology orthopedic division and with the operating units of Orthopedics A and B of our institution, reporting the type of intervention, results and complications of the procedures performed.Material and methodsFrom 2011 to 2019, were treated 32 patients affected by primitive and secondary musculoskeletal neoplasm with a mean age of 44 years (14-67 years) in 28 cases (87.5%) were required revascularization. Women accounted for 46.9% (15/32), 53.1% were men (17/32). The preoperative study included a biopsy of the lesion and ultrasonography and CTA with multiplanar reconstructions for the evaluation of the vascular anatomy and neoplasia extension.ResultsThe average postoperative follow-up was 20.1 months. The reconstruction of the vessels has been implemented in 14/32 (43.7%) mainly using the autologous saphenous contralateral vein. The use of the prosthesis was performed in the others cases (with PTFE and Dacron K prosthesis). In 5 cases (15.6%) the patients had lower limb edema, with a distance venous patency of 26/32 (81.2%) and arterial patency of 100%. We had no mortality at 30 days. Two patients underwent VAC therapy. No amputations were performed at 30 days. In 14 patients was performed perioperative chemotherapy or radiotherapy.ConclusionsA long-term evaluation is needed to determine the implications at distance, in patients undergoing radical resection of cancer in which are necessary for skills vascular surgery. The long term result is conditioned by the prognosis of neoplasm. The multidisciplinary approach is always requested.