Surgical outcomes of vascular reconstruction in soft tissue sarcomas of the lower extremities

Nishinari, Kenji; Krutman, Mariana; Aguiar, Samuel; Pignataro, Bruno Soriano; Yazbek, Guilherme; Bomfim, Guilherme Andre Zottele; Teivelis, Marcelo Passos; Wolosker, Nelson

doi:10.1016/j.jvs.2015.02.004

Cited by 41 publications

(25 citation statements)

References 15 publications

(10 reference statements)

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“…However, in sarcoma surgery in contrast to obstructive arterial disease, there are some specific situations, such as requirement of a relatively short graft, not atherosclerotic artery, and postoperative formation of arterial collateral. In this review, only two small comparative studies without uniform follow‐up protocol reported an overall limb‐salvage rate between autologous and synthetic graft; one study reported that vascular reconstruction using autologous graft had a significantly higher patency rate than reconstruction with synthetic graft in their 25 patients (Nishinari et al, ); however, the other study suggested no significant differences between the graft materials in their 14 patients (Schwarzbach et al, ). The impact of graft material selection on limb‐salvage rate remains unclear in the current data set; therefore, it is necessary to compare the long‐term results between the graft materials with a randomized control trial or large prospective study before any definitive statement can be made.…”

Section: Discussionmentioning

confidence: 97%

“…Anticoagulation therapy followed by vascular reconstruction was reported in 14 studies (Adelani et al, 2007;Akgül et al, 2018;Baxter et al, 2007;Bonardelli et al, 2000;Emori et al, 2012;Ghert et al, 2005;Kawai et al, 1996;Koperna et al, 1996;Muramatsu et al, 2011;Nishinari et al, 2015;Schwarzbach et al, 2005;Spark et al, 2009;Tsukushi et al, 2008;Umezawa et al, 2013). Use of anticoagulation regimens varied widely across the studies, with 10 studies reporting intraoperative and postoperative use of heparin or lowmolecular-weight heparin.…”

Section: Reconstructive Proceduresmentioning

confidence: 99%

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Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

2020

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Background Limb‐salvage surgery with vascular reconstruction is the current standard treatment when sarcoma involves major vessels of the lower extremity. However, the low incidence of sarcoma and rarity of limb‐salvage surgery are limiting factors for the reliable study of limb‐salvage surgery. Therefore, a systematic review was conducted to establish better management of lower extremity sarcoma based on currently available evidence. Methods A systematic review and meta‐analysis of data on limb‐salvage surgery with vascular reconstruction for lower extremity sarcoma were conducted using MEDLINE through PubMed, Scopus, CINARL, and Cochrane Database of Systematic Reviews. Overall limb‐salvage rate was the primary outcome, and rates of perioperative complication and arterial patency were secondary outcomes. Results Among the 271 patients (18 studies) included in this study, 69.4% underwent arterial reconstruction with autologous graft, 22.0% underwent synthetic graft, and 8.6% underwent other reconstructive methods. Pooled overall limb‐salvage rate was 89.8% [95% confidence interval (CI), 85.0–93.1%] after a mean follow‐up of 19–74.7 months. Pooled overall perioperative complication and arterial patency rates were 49.5% (95% CI, 42.8–56.2%) and 85.4% (95% CI, 79.5–89.9%), respectively. Conclusions Current evidence suggests that limb‐salvage surgery with vascular reconstruction has a high limb‐salvage rate; however, the high perioperative complication rate remains problematic. Early and appropriate interventions are required to optimize the complications of limb‐salvage surgery.

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Section: Discussionmentioning

confidence: 97%

Section: Reconstructive Proceduresmentioning

confidence: 99%

Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

2020

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“…Graft occlusion rates were found to be significantly greater in patients who received synthetic grafts vs. those who received saphenous vein grafts (P = 0.02), which is consistent with the results of other studies [14] . However occlusion rates were not different between arterial and venous reconstruction and there was no association between prior radiotherapy and graft occlusion [44] . Wortman et al [45] reported one-year patency rates of venous bypass grafts to be 65%, with high numbers of overall bypass-related complications including thrombosis and emboli as well as infections.…”

Section: Vascular Reconstructionmentioning

confidence: 74%

“…Studies showing high occlusion rates have led to debates regarding the benefits of venous revascularization [43] . Additionally, there have been reports of symptoms of severe venous insufficiency such as edema, claudication, and hyperpigmentation after reconstruction [44] .…”

Section: Vascular Reconstructionmentioning

confidence: 99%

“…A large series of lower limb soft tissue sarcoma resection with arterial and venous reconstruction was conducted by Nishinari et al [44] in 25 patients. Graft occlusion rates were found to be significantly greater in patients who received synthetic grafts vs. those who received saphenous vein grafts (P = 0.02), which is consistent with the results of other studies [14] .…”

Section: Vascular Reconstructionmentioning

confidence: 99%

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Complex reconstruction of the lower extremity following sarcoma resection: a literature review

Azadgoli¹,

Carre²,

Perrault³

et al. 2018

PAR

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While amputation was traditionally the only option available for patients with sarcomas of the extremities, chemotherapy, radiation, and advances in microsurgical technique have allowed many patients to undergo limb-salvaging procedures. Given the low incidence and heterogeneity of these tumors, there is currently no standard treatment algorithm for limb reconstruction after large sarcoma resection. Thus, we systematically reviewed the various types of free tissue transfer used for the reconstruction of lower limbs after sarcoma resection. Techniques were described based on anatomic location. This literature review supports free tissue transfer as a safe and acceptable modality for reconstruction after sarcoma resection of the lower limb. It allows for the application of healthy vascularized tissue to the defect while also providing freedom of flap positioning. Flap choice is dependent on tumor and defect size, tissue type and function, as well as donor site availability.

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Vascular reconstruction using autologous vs synthetic graft for patients with extremity soft‐tissue sarcoma involving the major vessels

Mlees

El‐Barbary

Sallam

2019

Journal of Surgical Oncology

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ObjectiveArterial reconstruction after radical limb‐sparing resection of extremity soft‐tissue sarcoma (STS) involving great vessels is necessary. However, there is no agreement upon the optimal vascular substitute. This study prospectively evaluated the major vascular reconstructions in extremity STS surgery with vascular involvement.Patients and MethodsBetween June 2017 and August 2019, 29 patients having extremity STS with major vascular reconstruction were enrolled. Recurrent, metastatic STSs or STSs of vascular origin were excluded. Patients were non‐randomly divided into two groups according to the type of arterial substitute: group I, autologous graft (16 patients) and group II, synthetic graft (13 patients). Graft patency, postoperative morbidity, and patient and limb survival were analyzed.ResultsThe mean follow‐up was 12 months (range, 6‐26). Early postoperative complications and overall survival were nonsignificantly different between groups. The 1‐year primary patency was 92.85% vs 90% in groups I vs II, respectively, P = .704. Graft occlusion was nonsignificantly greater in the synthetic group, P = .107. Limb salvage was 93.75% in group I compared with 92.3% in group II, P = .87.ConclusionsGraft choice should be based on autologous vein suitability regarding its length and caliber. If such requirements are not available, synthetic substitutes can be used with close surveillance of patency.

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Surgical outcomes of vascular reconstruction in soft tissue sarcomas of the lower extremities

Cited by 41 publications

References 15 publications

Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

Complex reconstruction of the lower extremity following sarcoma resection: a literature review

Vascular reconstruction using autologous vs synthetic graft for patients with extremity soft‐tissue sarcoma involving the major vessels

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