Temporary arterial clamping in major musculoskeletal malignant tumour surgery: A two-centre comparative study
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Published on: July 5, 2024
Güray Altun1, Murat Sarıkaş2, Oğuzhan Özyaman3
1Department of Orthopaedics and Traumatology, Middle East Hospital, Adana, Türkiye.
Background And Objectives:
The aim of this study was to assess the safety of temporary arterial clamping in major musculoskeletal malignant tumour surgery and its impact on blood loss and related complications.
Materials And Methods:
A retrospective evaluation was conducted on 62 consecutive patients who underwent surgical resection for malignant musculoskeletal tumours between October 2020 and December 2023. The patients were categorised into two groups: Group 1 (n = 31) underwent wide resection of the tumour using temporary arterial clamping proximal to the tumour volume, whereas Group 2 (n = 31) underwent wide resection without vascular clamping. The intraoperative, total (intraoperative + postoperative) blood loss per cm3 of the tumour volume, operating time, and complications were evaluated.
Results:
In Group 1, the median operating time was 309 minutes (range, 208-458), the median intraoperative blood loss was 1815 mL (range, 1047-2683), and the median total blood loss was 2688 mL (range, 2084-4212). The median intraoperative and total blood loss volumes normalised to tumour volume were 2.35 mL/cm3 (range, 1.17-5.30) and 4.27 mL/cm3 (range, 2.2-10.67), respectively. In Group 2, the median operating time was 190 minutes (range, 150-300), the median intraoperative blood loss was 887 mL (range, 597- 1589), and the median total blood loss was 1813 mL (range, 1372-2514). The median intraoperative and total blood loss volumes normalised to tumour volume were 12.11 mL/cm3 (range, 10.44-46.90) and 36.14 mL/cm3 (range, 24.69-78.25), respectively. Total and intraoperative blood loss volumes were significantly higher in Group 1 (p = 0.003 and p = 0.002, respectively). However, total and intraoperative blood loss volumes normalised to tumour volume (mL/cm3) were significantly lower in Group 1 (p < 0.001 and p < 0.001, respectively).
Conclusion:
The use of temporary arterial clamping during the surgical resection of musculoskeletal tumours appears to be a safe practice that can reduce intraoperative and postoperative haemorrhage without increasing complications.