Limb-sparing surgery with vascular reconstruction for malignant lower extremity soft tissue sarcoma

• Published in: Journal of vascular surgery Vol. 65; no. 1; pp. 151 - 156
• Main Authors: Davis, Laura A., MD, Dandachli, Firas, MD, Turcotte, Robert, MD, Steinmetz, Oren K., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2017
• Subjects: Adult; Aged; Female; Hospitals, High-Volume; Humans; Kaplan-Meier Estimate; Limb Salvage - adverse effects; Limb Salvage - mortality; Lower Extremity - blood supply; Lower Extremity - pathology; Lower Extremity - surgery; Male; Middle Aged; Postoperative Complications - etiology; Postoperative Complications - surgery; Recovery of Function; Registries; Reoperation; Risk Factors; Sarcoma - mortality; Sarcoma - pathology; Sarcoma - surgery; Soft Tissue Neoplasms - mortality; Soft Tissue Neoplasms - pathology; Soft Tissue Neoplasms - surgery; Surgery; Time Factors; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; Wound Healing; Young Adult
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2016.05.094

Abstract Background The standard of care for lower extremity soft tissue sarcoma (STS) is limb-sparing surgery. A small subset of these patients will require concomitant vascular reconstruction to ensure adequate resection and to preserve limb viability and function. The aim of this study was to evaluate outcomes in these patients with respect to wound healing and postoperative functional status. Methods Outcomes for a total of 154 patients treated for malignant lower extremity STS during an 8-year period between 2005 and 2013 were entered in a prospective registry. Treatment was by medical management in 3 patients (2%), limb-sparing surgery with vascular reconstruction (LSVR) in 9 patients (6%), and limb-sparing surgery without vascular reconstruction (LS) in 142 patients (92%). The registry and patient records and the intraoperative records were consulted to determine the primary outcomes of patient survival and time for complete wound healing. The functional status of patients was assessed using the Musculoskeletal Tumor Society (MSTS) functional assessment score before surgery and at 6 and 12 months after surgery. Results Mean follow-up time was 74.7 months for the LSVR group and 53.4 months for the LS group. The mean time to complete wound healing was significantly longer in LSVR vs LS patients (88 days vs 34 days, respectively; P  = .002), and overall survival was lower in LSVR patients ( P  = .01). Seven of the 9 LSVR patients required a total of 12 additional procedures to achieve wound healing, including 9 procedures to drain seromas (incision and drainage) with vacuum-assisted closure in 4 cases. Plastic surgery intervention was required in three patients, including one skin graft, one gracilis pedicle flap, and one vertical rectus abdominis myocutaneous flap. There was no significant difference in the mean MSTS scores preoperatively, at 6 months, and at 1 year after surgery between the two groups (27, 25, and 29 for LSVR vs 28, 31, and 31 for LS, respectively; P  = .63, .11, and .67, respectively). Conclusions The need for vascular reconstruction during limb-sparing surgery for lower extremity malignant STS is rare in a high-volume sarcoma center. Overall survival was lower in these patients, and the time to complete wound healing is prolonged and requires multiple secondary interventions. However, postoperative functional status as assessed by the MSTS is acceptable and comparable to that of patients not requiring vascular reconstruction.