Limb sparing surgical resection of groin sarcoma. Surgical approach and reconstructive options.
OBJECTIVE
The aim of this study is to evaluate limb sparing surgical resection and reconstructive options in a group of patients having soft tissue sarcoma of the groin and nearly most of them were previously subjected elsewhere to some sort of mismanagement.


METHODS
Between 2001 and 2006, 14 patients having soft tissue sarcoma of the groin presented to National Cancer Institute with some sort of mismanagement elsewhere. Preoperative reevaluation included CT chest, MRI or MRA, Doppler US and angiography in some selected patients. According to the Enneking staging system, 9 patients had stage II, 4 had stage IIA and 1 patient had stage III. Limb sparing resection was done including wide resection of the tumor enbloc with the pubic bone or its rami and involved femoral vessels and nerve. Abdominal wall defect was reconstructed by mesh, skin defect was reconstructed by local myocutaneous flaps and vascular replacement was done by vascular prosthesis.


RESULTS
The mean follow-up period was 31 months (range 25-53 months). Surgical margins were negative in 13 patients and microscopically positive in one patient. Femoral nerve was resected in 3 cases. Pubic bone resection was done in all patients. Vascular resection and prothetic replacement were done in 2 cases. Ten cases required myocutaneous flap reconstruction of skin defect, 2 cases required muscle flap only. All mobilized flaps showed no failure. Complications included seroma in all cases, superficial stitch gaping in 3 cases, wound breakdown and deep infection occurred in one case and chronic lymphedema in 5 cases. Limb sparing function according to MSTS functional score ranged from 92 % to 97 %. The 2 year local control rate was 92.8 % and the 2 years survival rate was 85.7 %.


CONCLUSIONS
Patients having groin sarcoma with some sort of improper management may still have a chance of successful limb sparing surgical resection with a curative intent and achievement of good functional results. This requires proper preoperative reevaluation of the extension of the tumor and vascular involvement, wide retroperitoneal exposure to maximize tumor resection, vascular replacement if ileofemoral vessels are involved and local myocutaneous flap transfer to minimize the problems of wound healing and subsequent infection.


BACKGROUND
Groin sarcoma - Limb salvage - Groin defect reconstruction.
El-Sherbiny
Magdy
M
The Department of Surgery, National Cancer Institute, Cairo University.