Safety and Feasibility of Limb Salvage Surgery in Patients with Extremity Sarcoma and Major Vessel Abutment: A...

The aim of this study was to evaluate the function of limbs after limb salvage surgery (LSS) for extremity sarcoma (ES) with major vessel abutment. A total of 13 patients with high-grade ES were included and categorized into the following based on the pre-operative MRI after neoadjuvant treatment: (1) type 1-not involved, (2) type 2a-loss of fat plane less than 180°, (3) type 2b-loss of fat plane more than 180°, and (4) type 3-encased artery. All patients underwent wide resection and vascular reconstruction for type 3 as well as vascular release for other types. The post-op complications and limb salvage rate were studied as well. The mean follow-up time was 20.0 ± 10.17 months (range 12-40). Post-operative complications were limb edema (38.5%), infection (7.7%), wound dehiscence (7.7%) treated with negative pressure wound therapy, local recurrence (15.4%), graft thrombosis (15.4%) treated with thrombectomy, post-operative metastasis (15.4%), and secondary amputation (7.7%). There was no correlation between complications and age, gender, infiltration status, sarcoma type, vascular grade, operation time, recurrence status, tumor size, tumor necrosis, and margin status. Although the overall complication rate was 69.23%, the limb salvage rate was 92.3%. The mean MSTS was 81.70 ± 22.96 as well as 79.64 ± 21.36 for TESS. Although the post-op complication rate is high, LSS provides a functional limb in ES with vascular abutment. Vascular release has a high rate of limb salvage with acceptable functional outcomes in ES with vascular abutment.