title: Results of limb-sparing surgery with vascular replacement for soft tissue sarcoma in the lower extremity.
abstract: OBJECTIVE
  To evaluate limb-salvage surgery with vascular resection for lower extremity soft tissue sarcomas (STS) in adult patients and to classify blood vessel involvement.
  
  
  METHODS
  Subjects were consecutive patients (median age, 56 years) who underwent vascular replacement during surgery of STS in the lower limb between January 1988 and December 2003. Blood vessel involvement by STS was classified as follows: type I, artery and vein; type II, artery only; type III, vein only; and type IV, neither artery nor vein (excluded from the analysis). Patient data were prospectively gathered in a computerized database.
  
  
  RESULTS
  Twenty-one (9.9%) of 213 patients underwent vascular resections for lower limb STS. Besides 17 type I tumors (81.0%), 3 (14.3%) type II and 1 (4.7%) type III STS were diagnosed. Arterial reconstruction was performed for all type I and II tumors. Venous replacement in type I and III tumors was performed in 66.7% of patients. Autologous vein (n = 8) and synthetic (Dacron and expanded polytetrafluoroethylene; n = 12) bypasses were used with comparable frequency for arterial repair, whereas expanded polytetrafluoroethylene prostheses were implanted in veins. Morbidity was 57.2% (hematoma, thrombosis, and infection), and mortality was 5% (embolism). At a median follow-up of 34 months, the primary and secondary patency rates of arterial (venous) reconstructions were 58.3% (54.9%) and 78.3% (54.9%). Limb salvage was achieved in 94.1% of all cases. The 5-year local control rate and survival rate were 80.4% and 52%, respectively. We observed a 5-year metastasis-free survival rate of 37.7% and found vessel infiltration and higher tumor grade (low-grade vs intermediate grade and high grade tumors) to be negative prognostic factors at univariate and multivariate analysis.
  
  
  CONCLUSIONS
  Long-term bypass patency rates, the high percentage of limb salvage, and the oncologic outcome underline the efficacy of en bloc resection of STS involving major vessels in the lower limb. Disease-specific morbidity must be anticipated. The classification of vascular involvement (type I to IV) is useful for surgical management.
authors: Department of Vascular and Endovascular Surgery, University of Heidelberg, Mannheim, Germany. matthias.schwarzbach@chir.ma.uni-heidelberg.de
authors: Matthias H M
authors: MH
authors: Schwarzbach
authors: Yura
authors: Y
authors: Hormann
authors: Ulf
authors: U
authors: Hinz
authors: Ludger
authors: L
authors: Bernd
authors: Frank
authors: F
authors: Willeke
authors: Gunhild
authors: G
authors: Mechtersheimer
authors: Dittmar
authors: D
authors: Böckler
authors: Hardy
authors: H
authors: Schumacher
authors: Christian
authors: C
authors: Herfarth
authors: Markus W
authors: MW
authors: Büchler
authors: Jens-R
authors: JR
authors: Allenberg
mesh_terms: D000465:Algorithms; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006084:Graft Rejection; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D012501:Saphenous Vein / Q000637:transplantation; D012509:Sarcoma / Q000601:surgery*; D019043:Vascular Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
chemical_list: D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene