The surgical and functional outcome of limb-salvage surgery with vascular reconstruction for soft tissue sarcoma of the extremity.
BACKGROUND
This study compared the surgical, oncological, and functional outcomes of patients undergoing limb-salvage surgery for extremity soft tissue sarcoma with vascular resection and reconstruction with the outcomes of those undergoing limb-salvage without vascular reconstruction.


METHODS
Nineteen patients were identified from a prospective soft-tissue sarcoma database who underwent vascular resection and reconstruction as part of their limb-salvage surgery and who were followed up for at least 1 year or until death. Each of these 19 patients was case-matched to 2 additional patients on the basis of tumor location, size, and depth; patient age; and timing of radiation. To compare functional outcome, a subset of patients was case-matched with additional criteria including wound-complication status, motor nerve sacrifice, similar preoperative function as determined by the Toronto Extremity Salvage Score, and no metastases at diagnosis or the 1-year follow-up.


RESULTS
Patients in the vascular reconstruction group were more likely to require a muscle transfer (53% vs. 18%; P = .008), experience a wound complication (68% vs. 32%; P = .03), experience deep venous thrombosis (26% vs. 0; P = .003), experience significant limb edema (87% vs. 20%; P = .001), and ultimately require an amputation (16% vs. 3%; P = .07). Patients who underwent vascular reconstruction had only slightly lower Toronto Extremity Salvage Score scores 1 year after surgery (78.5 vs. 84.2; P = .35). There were no significant differences in local or systemic tumor relapse between the two groups.


CONCLUSIONS
Vascular reconstruction is a feasible option in limb-salvage surgery for soft tissue sarcoma but is associated with an increased risk for postoperative complications, including amputation. Although function is not significantly worse after vascular reconstruction, the results are less predictable.
Ghert
Michelle A
MA
University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 476E, Toronto, Ontario M6B 1H9, Canada.
Davis
Aileen M
AM
Griffin
Anthony M
AM
Alyami
Ali H
AH
White
Lawrence
L
Kandel
Rita A
RA
Ferguson
Peter
P
O'Sullivan
Brian
B
Catton
Charles N
CN
Lindsay
Thomas
T
Rubin
Barry
B
Bell
Robert S
RS
Wunder
Jay S
JS
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D018219:Histiocytoma, Benign Fibrous / Q000601:surgery; D006801:Humans; D007866:Leg / Q000294:innervation; D023821:Limb Salvage; D008080:Liposarcoma / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures