Limb Preservation Using Vascular Reconstruction in Patients with Large Extremity Soft Tissue Sarcomas: Results of Multi-Modality Therapy

Abstract

Management of extremity sarcoma has shifted from amputation to limb salvage surgery with improvements in surgical techniques and multimodality treatment protocols. For tumors involving major neurovascular bundles, it has not been accepted as a routine practice uniformly due to fear of oncological outcomes, postoperative morbidity, and lack of expertise in microvascular surgery. We analyzed our experience of limb salvage surgery with vascular reconstruction for extremity sarcomas. Retrospective analysis of patients with extremity sarcomas undergoing limb salvage surgery through vascular reconstruction was done. The feasibility, surgical, oncological, and functional outcomes of these patients was studied. Out of 176 patients undergoing limb preserving surgery for extremity sarcoma, limb salvage using vascular resection and reconstruction was done in 14 patients. Mean age of these 14 patients was 35.4 years (19–49). Arterial reconstruction was done in 7 patients, venous in 5, and in 2 patients both arterial and venous reconstructions were performed. All the 14 patients had tumor-free margins, and none had immediate post-operative graft failure requiring amputation. Post radiation graft exposure occurred in one patient. Involvement of major vascular bundle in extremity sarcomas should not always be considered a contraindication for limb preservation. Optimal oncological outcome with preserved limb function can be achieved by arteriovenous reconstructive procedures. In places with limited resources, autologous grafts are preferred because of constraints of availability and cost.