Results of surgery and multimodal therapy for patients with soft tissue sarcoma invading to vascular structures

The aim of this study was to analyze the impact of resection and reconstruction of major vessels on the limb salvage rate, local disease free survival, and overall survival for patients with soft tissue sarcomas invading to neurovascular bundles.

Twenty patients were treated in a 7-year period by one surgical team. Preoperative therapy consisted of isolated limb perfusion (n = 6), systemic chemotherapy (n = 4), systemic chemotherapy combined with regional hyperthermia (n = 2), and external beam irradiation (n = 1). All patients underwent resection of the sarcoma monobloc together with the neurovascular bundle invaded. Vessels were replaced by an autologous vein transplant or an allograft, and, in six patients, a myocutaneous flap or skin graft had to be used for soft tissue coverage.

Histologic examination revealed negative histologic margins (R0-resection) and infiltration of the neurovascular bundle in all patients. In four patients, a local recurrence was observed, and, in three of them, reresection with negative margins was achieved. The mean local recurrence free survival was 54 months (confidence interval [CI], 42-66 months), and the mean overall survival was 48 months (CI, 32-57 months). Limb salvage was achieved in 19 of 20 patients. Eleven patients developed distant metastases after a mean survival time of 30 months.

Extended sarcoma resection, including vessel replacement after preoperative multimodal therapy, provides long term local control and limb salvage. Amputation of extremity sarcoma can hardly be justified, even in cases of tumor invasion to neurovascular bundles. However, efforts to achieve better control over systemic spread are required for long term disease free survival.