Analysis of immediate vascular reconstruction for lower-limb salvage in patients with lower-limb bone and soft-tissue sarcoma

Umezawa, Hiroki; Sakuraba, Minoru; Miyamoto, Shinpei; Nagamatsu, Shougo; Kayano, Shuji; Taji, Megumi

doi:10.1016/j.bjps.2013.01.001

Cited by 23 publications

(31 citation statements)

References 28 publications

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“…The most common complication following limb‐salvage surgery was limb edema that occurred in 16.7% of patients. Although the standard prophylactic approach of postoperative edema after lower extremity sarcoma surgery presently has not been established, some reports suggested venous reconstruction would be useful to prevent or reduce postoperative limb edema (Emori et al, ; Okamoto et al, ; Umezawa et al, ). The present review revealed that the venous reconstruction following venous resection was performed in 78.9% of patients with venous resection, but the detailed indication of venous reconstruction was described in only six studies.…”

Section: Discussionmentioning

confidence: 99%

Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

2020

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Background Limb‐salvage surgery with vascular reconstruction is the current standard treatment when sarcoma involves major vessels of the lower extremity. However, the low incidence of sarcoma and rarity of limb‐salvage surgery are limiting factors for the reliable study of limb‐salvage surgery. Therefore, a systematic review was conducted to establish better management of lower extremity sarcoma based on currently available evidence. Methods A systematic review and meta‐analysis of data on limb‐salvage surgery with vascular reconstruction for lower extremity sarcoma were conducted using MEDLINE through PubMed, Scopus, CINARL, and Cochrane Database of Systematic Reviews. Overall limb‐salvage rate was the primary outcome, and rates of perioperative complication and arterial patency were secondary outcomes. Results Among the 271 patients (18 studies) included in this study, 69.4% underwent arterial reconstruction with autologous graft, 22.0% underwent synthetic graft, and 8.6% underwent other reconstructive methods. Pooled overall limb‐salvage rate was 89.8% [95% confidence interval (CI), 85.0–93.1%] after a mean follow‐up of 19–74.7 months. Pooled overall perioperative complication and arterial patency rates were 49.5% (95% CI, 42.8–56.2%) and 85.4% (95% CI, 79.5–89.9%), respectively. Conclusions Current evidence suggests that limb‐salvage surgery with vascular reconstruction has a high limb‐salvage rate; however, the high perioperative complication rate remains problematic. Early and appropriate interventions are required to optimize the complications of limb‐salvage surgery.

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Section: Discussionmentioning

confidence: 99%

Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

2020

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“…Furthermore, both Tsukushi et al [27] and Adelani et al [28] have found no reduction in post-operative oedema when venous reconstruction was performed. Despite these observations, a majority of reports describe attempts made by surgeons to reconstruct the venous system in every case, or at least in those cases where sufficient concern exists for collateral flow [5,7,8,18,19,21] . It may well be that the rate of postoperative oedema correlates closely with the degree of disruption of venous collaterals at the time of surgical resection.…”

Section: General Principles Of Surgical Techniquementioning

confidence: 99%

“…Saphenous (10), PTFE (2) Emori et al [8] 9 PTFE (9) Viñals Viñals et al [38] 1 Saphenous (1) 100% Umezawa et al [7] 13…”

Section: Number (N ) Graft Materials (N ) Patencymentioning

confidence: 99%

“…A number of vascular reconstructive options are available to the surgeon, and the choice of specific graft depends on the length and caliber of vessel required, the availability of suitable venous graft in the contralateral limb, and surgeon experience and preference. Options variously described in the literature include contralateral superficial femoral vein graft, reversed long saphenous vein graft, or synthetic grafts such as polytetrafluoroethylene or polyethylene terephthalate [5,7,8,15,[18][19][20][21][22] . Routinely patients should receive prophylactic antibiotic treatment, and a closed suction drain may also be placed at time of closure.…”

Section: General Principles Of Surgical Techniquementioning

confidence: 99%

“…Magnetic resonance imaging (MRI) has now become the gold standard of work-up for soft tissue sarcoma and should be performed to evaluate any suspicious lesions. However, colour duplex sonography, computed tomography (CT) and formal angiography have all been reported modalities used in the diagnosis of a soft tissue sarcoma invading vascular structures [5,[7][8][9] . The addition of radiographic contrast to the study helps delineate vascular structures.…”

Section: Investigationmentioning

confidence: 99%

See 2 more Smart Citations

Resection and reconstruction of pelvic and extremity soft tissue sarcomas with major vascular involvement: Current concepts

McGoldrick¹,

Butler²,

Lavelle³

et al. 2016

WJO

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Soft tissue sarcoma accounts for approximately 1% of all cancers diagnosed annually in the United States. When these rare malignant mesodermal tumours arise in the pelvis and extremities, they may potentially encase or invade large calibre vascular structures. This presents a major challenge in terms of safe excision while also leaving acceptable surgical margins. In recent times, the trend has been towards limb salvage with vascular reconstruction in preference to amputation. Newer orthopaedic and vascular reconstructive techniques including both synthetic and autogenous graft reconstruction have made complex limb-salvage surgery feasible. Despite this, limb-salvage surgery with concomitant vascular reconstruction remains associated with higher rates of post-operative complications including infection and amputation. In this review we describe the initial presentation and investigation of patients presenting with soft tissue sarcomas in the pelvis and extremities, which involve vascular structures. We further discuss the key surgical reconstructive principles and techniques available for the management of these complex tumours, drawn from our institution's experience as a national tertiary referral sarcoma service.

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Surgical and oncologic outcomes following arterial resection and reconstruction for advanced solid tumors

Cruz

Basmaci

Bateni

et al. 2021

Journal of Surgical Oncology

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Background and Objectives: Although arterial involvement for advanced tumors is rare, vascular resection may be indicated to achieve complete tumor resection.Given the potential morbidity of this approach, we sought to evaluate perioperative outcomes, vascular graft patency, and survival among patients undergoing tumor excision with en bloc arterial resection and reconstruction.Methods: From 2010 to 2020, we identified nine patients with tumors encasing or extensively abutting major arterial structures for whom en bloc arterial resection and reconstruction was performed.Results: Mean age was 53 ± 20 years, and 89% were females. Diagnoses were primary sarcomas (5), recurrent gynecologic carcinomas (3), and benign retroperitoneal fibrosis (1). Tumors involved the infrarenal aorta (2), iliac arteries (6), and superficial femoral artery (1). Three patients (33%) had severe perioperative morbidity (Grade III + ) with no mortality. At a median follow-up of 23 months, eight patients (89%) had primary graft patency, and five patients (56%) had no evidence of disease.Conclusions: Arterial resection and reconstruction as part of the multimodality treatment of regionally advanced tumors is associated with acceptable short-and long-term outcomes, including excellent graft patency. In appropriately selected patients, involvement of major arterial structures should not be viewed as a contraindication to attempted curative surgery.

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Analysis of immediate vascular reconstruction for lower-limb salvage in patients with lower-limb bone and soft-tissue sarcoma

Cited by 23 publications

References 28 publications

Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

Resection and reconstruction of pelvic and extremity soft tissue sarcomas with major vascular involvement: Current concepts

Surgical and oncologic outcomes following arterial resection and reconstruction for advanced solid tumors

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