Clinical outcomes after wide resection of lower extremity soft tissue sarcomas with femoral vessel reconstruction

Abstract

Introduction With advancements in local control of lower extremity soft tissue sarcoma (STS) by modern oncology protocols, limb salvage surgeries have become the standard of care with good results in both limb function outcome and quality of life. Patients and methods This is a retrospective analysis of all patients with a localized STS of the lower extremity presented to Vascular Surgery Unit at Faculty of Medicine, Cairo University, and who underwent en bloc vascular resection of the tumor between January 2018 and April 2019. Results We have found 17 patients during the study period. In three patients, iliofemoral arterial repairs were performed. Above-the-knee femoropopliteal bypasses were implanted in six patients. In four patients, popliteoposterior tibial bypasses were performed. Venous reconstructions consisted of three iliofemoral, one femorofemoral, and four femoropopliteal bypass reconstructions. Another four venous reconstructions were performed in the popliteal region. All patients developed moderate degree of pitting lower limb edema at the early postoperative period. Only one patient had undergone lower limb above-knee amputation. There was one synthetic Dacron graft occlusion in a patient with arterial bypass procedures. Regarding venous bypasses, occlusion occurred in three patients. Freedom from local tumor recurrence at 6 months was 64.2%. The freedom from distant metastases at 6 months after primary tumor excision was 85.7% for more than 10 mm margins and 20% for less than or equal to 10 mm margins. The cumulative overall survival proportion at 6 months was 53.9%. Conclusion Vascular reconstruction after wide local excision of lower extremity STS prevents the complications of vascular ligation and local recurrence in case of subradical excision. The use of autogenous vein graft yields better patency rates than synthetic grafts.