Complications Following Pre-Operative Radiotherapy and Vascular Reconstruction to the Groin in Sarcoma Patients: A Series of Cases

Abstract

Background: The mainstay of therapy in most soft tissue sarcomas is a combination of surgery and radiotherapy. Although aimed directly at the tumor, radiotherapy may also cause damage to surrounding tissue, particularly at therapeutic levels. In most cases, irritated tissue will heal well, although some longlasting effects may remain. In patients presenting with large sarcomas near the groin, pre-operative radiotherapy followed by radical excision and vascular reconstruction is a common practice. However, neither synthetic vascular grafts nor venous autografts tend to react well to radiotherapy. Case Presentation: In this case series, we report 3 patients who underwent pre-operative radiotherapy prior to vascular reconstructive surgery. In all 3 cases, many post-operative complications necessitated multiple further operations. Two of the 3 eventually required an above and below knee amputation, and the third developed sepsis and pulmonary metastasis. We discuss the role of pre-operative radiotherapy and vascular reconstruction to the groin in sarcoma patients, and query whether this combination could be reconsidered given the potential consequences. We also discuss the efficacy of a lower therapeutic radiotherapy dose and the effect this may have on surgical outcomes. Conclusion: The combination of pre-operative radiotherapy and vascular reconstruction to the groin in sarcoma patients may carry significant morbidity, thereby putting the limb and/or life at risk. The need for pre-operative radiotherapy in groin sarcoma patients requiring vascular reconstruction should therefore be considered very carefully by an expert multidisciplinary team. Post-operative radiotherapy may be a suitable alternative.