title: Extended indications for functional limb-sparing surgery in extremity sarcoma using complex reconstruction.
abstract: From 1980 to 1991, 29 patients underwent complex reconstruction following extremity sarcoma resection. Soft tissue was the site of origin in 15 patients (52%) and bone was the site of origin in 14 patients (48%), with 20 sarcomas (69%) in the lower extremity. Resection consisted of the following procedures: extended anatomical soft-tissue resections (21 patients [72%]), bone resections (18 patients [62%]), and joint resections (14 patients [48%]). Reconstruction involved the following: myocutaneous flaps (20 patients [69%]), joint prosthesis (eight patients [28%]), and bone reconstruction (15 patients [52%]). There was no surgical mortality; one patient required an amputation owing to surgical complications. The site of the first failure was local (four [31%] of 13 patients), lung (five patients [38%]), others (four patients [31%]). At a median follow-up of 23 months, 18 patients (62%) had no evidence of disease, 27 (93%) had no local disease, 21 (72%) had good extremity function, three (10%) had major disabilities, and five (17%) underwent amputations. Local control improved when the margin of resection was larger than 10 mm. Disease-free survival was 67% at 3 years. Overall survival was 51% at 5 years. Tumor size was an independent predictor of overall survival. Local recurrence did not affect overall survival.
authors.affiliation: Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, Calif. 91010.
authors.forename: I B
authors.initials: IB
authors.lastname: Paz
authors.forename: L D
authors.initials: LD
authors.lastname: Wagman
authors.forename: J J
authors.initials: JJ
authors.lastname: Terz
authors.forename: B
authors.initials: B
authors.lastname: Chandrasekhar
authors.forename: J A
authors.initials: JA
authors.lastname: Lorant
authors.forename: G M
authors.initials: GM
authors.lastname: Moscarello
authors.forename: T
authors.initials: T
authors.lastname: Odom-Maryon
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods / Q000592:standards; D002140:California / Q000453:epidemiology; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005121:Extremities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis / Q000379:methods / Q000592:standards; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009985:Orthopedics / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D011878:Radiotherapy; D012509:Sarcoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D013518:Surgery, Plastic / Q000379:methods* / Q000592:standards; D013524:Surgical Flaps / Q000379:methods / Q000592:standards; D015996:Survival Rate; D016896:Treatment Outcome