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

Area of Science:

• Oncology
• Surgical Oncology
• Orthopedic Oncology

Background:

• Limb-sparing surgery is standard for lower extremity soft tissue sarcoma (STS).
• A subset of STS patients require vascular reconstruction for resection and limb preservation.
• Evaluating outcomes of STS patients undergoing vascular reconstruction is crucial.

Purpose of the Study:

• To assess wound healing and functional outcomes in lower extremity STS patients undergoing limb-sparing surgery with vascular reconstruction (LSVR).
• To compare outcomes between LSVR and limb-sparing surgery without vascular reconstruction (LS).

Main Methods:

• A prospective registry of 154 lower extremity malignant STS patients (2005-2013).
• Patients were categorized into LSVR (9 patients) and LS (142 patients) groups.
• Outcomes included patient survival, time to wound healing, and Musculoskeletal Tumor Society (MSTS) functional scores.

Main Results:

• LSVR patients had significantly longer wound healing times (88 vs 34 days) and lower overall survival (P=.01).
• Seven of nine LSVR patients required additional procedures for wound healing, including plastic surgery interventions.
• No significant difference in MSTS functional scores was observed between LSVR and LS groups postoperatively.

Conclusions:

• Vascular reconstruction in lower extremity STS is rare but associated with poorer survival and delayed wound healing.
• Despite complications, functional outcomes (MSTS scores) are comparable to patients without vascular reconstruction.
• This study highlights the challenges and acceptable functional results in a select group of STS patients requiring LSVR.