Outcomes after Arterial or Venous Reconstructions in Limb Salvage Surgery for Extremity Soft Tissue Sarcoma

Park, Daedo; Cho, Sungsin; Han, Ahram; Choi, Chanjoong; Ahn, Sungyoon; Min, Sang Il; Ha, Jong‐Won; Min, Seung-Kee

doi:10.3346/jkms.2018.33.e265

Cited by 10 publications

(12 citation statements)

References 14 publications

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“…However, limb salvage surgery with vascular reconstruction is currently considered the standard treatment for ESTS because surgical resection with adequately wide margins showed equivalent oncologic results and significantly better QOL than amputation [32]. To ensure better oncologic control, it is recommended that whenever it is impossible to achieve a wide resection margin without vascular resection, active vascular resection be indicated [33–35]. There is a critical role of vascular surgeons in the curative surgery for ESTS.…”

Section: Various Roles Of Vascular Surgeons During Cancer Surgerymentioning

confidence: 99%

“…We previously reported the outcomes after arterial or venous reconstructions in limb salvage surgery for ESTS [35]. The autologous vein conduit showed better 2-year graft patency than that with the prosthetic graft (83.3% vs. 14.3%, P<0.001), and venous reconstruction showed more occlusions than arterial reconstruction, although the difference was insignificant (38.5% vs. 21.4%, P=0.37).…”

Section: Various Roles Of Vascular Surgeons During Cancer Surgerymentioning

confidence: 99%

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Oncovascular Surgery: Essential Roles of Vascular Surgeons in Cancer Surgery

Han

Ahn

Min

2019

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For the modern practice of cancer surgery, the concept of oncovascular surgery (OVS), defined as cancer resection with concurrent ligation or reconstruction of a major vascular structure, can be very important. OVS for advanced cancers requires specialized procedures performed by a specialized multidisciplinary team. Roles of oncovascular surgeons are summarized as: a primary surgeon in vesselorigin tumors, a rescue surgeon treating complications during cancer surgery, and a consultant surgeon as a multidisciplinary team for cancer surgery. Vascular surgeons must show leadership in cancer surgery in cases of complex advanced diseases, such as angiosarcoma, leiomyosarcoma, intravenous leiomyomatosis, retroperitoneal soft tissue sarcoma, iatrogenic injury of the major vessels during cancer surgery, pancreatic cancer with vascular invasion, extremity soft tissue sarcoma, melanoma and others.

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Section: Various Roles Of Vascular Surgeons During Cancer Surgerymentioning

confidence: 99%

Section: Various Roles Of Vascular Surgeons During Cancer Surgerymentioning

confidence: 99%

Oncovascular Surgery: Essential Roles of Vascular Surgeons in Cancer Surgery

Han

Ahn

Min

2019

VSI

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“…Locally advanced tumors involving major vascular structures were considered an indication for limb salvage [ 5 ]. Advancements in surgical skill and imaging modalities have made en bloc resection of the tumor with affected vascular structures possible [ 5 , 10 ], Vascular reconstructions after en bloc resection of the tumor and vessels were successfully performed despite difficult surgery, longer operating time, and limited patency (in some cases) [ 1 ]. Vascular surgeons were often involved as “reconstructive surgeons” during these procedures because of their unique skills in dealing with vessels [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Soft tissue and bone sarcomas are rare malignant neoplasms that account for less than 1% of all cancers diagnosed annually in the United States [ 1 ]. According to the Madras Metropolitan Tumor Registry, bone sarcomas and soft tissue sarcomas account for 1.1% and 1.2% of all cancers in women and 0.9% and 1.1% of all cancers in men, respectively [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Patients having extremity soft tissue sarcomas (ESTS) or bone sarcomas with vascular involvement require multimodal management to achieve limb salvage. Limb salvage surgery offers significantly better functional outcomes and quality of life compared to amputation, even in patients with distant metastasis [ 1 ]. In the present study, we review our experience with en bloc resection of the tumor and blood vessels followed by immediate reconstruction to achieve limb salvage.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Vascular Resection and Reconstruction in Extremity Soft Tissue Sarcoma and Bone Tumors

Shah

Ramanujan

Muralidharan

et al. 2021

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Purpose This study aimed to evaluate and analyze the feasibility and the oncological and functional outcomes of limb salvage surgery in extremity soft tissue sarcomas (ESTS) and bone tumors invading vessels. Methods Materials and This single-center retrospective analysis included patients with ESTS encasing or invading major blood vessels that were treated by limb salvage surgery with vascular resection and reconstruction between January 1995 and December 2019. Patients with contiguous involvement of major blood vessels and nerves and patients requiring amputation were excluded from the study. Results A total of 24 vessels (14 arteries and 10 veins) in 14 patients were reconstructed. Ten (71.4%) patients underwent both arterial and venous reconstruction, and four (28.6%) underwent only arterial reconstruction. Reconstruction was performed with a reversed saphenous vein (RSV) graft in 12 patients and with a synthetic graft (SG) in the other 12 patients. At a median follow-up of 27 months, RSV grafts were patent in 10 of 12 (83.3%) vessels and SGs were patent in 6 of 12 (50.0%) vessels (log-rank test, P=0.083). Out of 14 arteries and 10 veins, 11 arteries and 5 veins were patent, respectively. No patient developed local recurrence, and 2 (14.3%) patients developed distant metastases. Limb salvage rate was 13/14 (92.9%). The mean Musculoskeletal Tumor Society score was 83.3%. The 5- and 10-year overall survival rates were 80% and 50%, respectively. Conclusion Limb salvage surgery in ESTS with vascular resection and reconstruction is feasible and provides favorable oncological and functional outcomes.

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Vascular reconstruction using autologous vs synthetic graft for patients with extremity soft‐tissue sarcoma involving the major vessels

Mlees

El‐Barbary

Sallam

2019

Journal of Surgical Oncology

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ObjectiveArterial reconstruction after radical limb‐sparing resection of extremity soft‐tissue sarcoma (STS) involving great vessels is necessary. However, there is no agreement upon the optimal vascular substitute. This study prospectively evaluated the major vascular reconstructions in extremity STS surgery with vascular involvement.Patients and MethodsBetween June 2017 and August 2019, 29 patients having extremity STS with major vascular reconstruction were enrolled. Recurrent, metastatic STSs or STSs of vascular origin were excluded. Patients were non‐randomly divided into two groups according to the type of arterial substitute: group I, autologous graft (16 patients) and group II, synthetic graft (13 patients). Graft patency, postoperative morbidity, and patient and limb survival were analyzed.ResultsThe mean follow‐up was 12 months (range, 6‐26). Early postoperative complications and overall survival were nonsignificantly different between groups. The 1‐year primary patency was 92.85% vs 90% in groups I vs II, respectively, P = .704. Graft occlusion was nonsignificantly greater in the synthetic group, P = .107. Limb salvage was 93.75% in group I compared with 92.3% in group II, P = .87.ConclusionsGraft choice should be based on autologous vein suitability regarding its length and caliber. If such requirements are not available, synthetic substitutes can be used with close surveillance of patency.

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Outcomes after Arterial or Venous Reconstructions in Limb Salvage Surgery for Extremity Soft Tissue Sarcoma

Cited by 10 publications

References 14 publications

Oncovascular Surgery: Essential Roles of Vascular Surgeons in Cancer Surgery

Oncovascular Surgery: Essential Roles of Vascular Surgeons in Cancer Surgery

Outcomes of Vascular Resection and Reconstruction in Extremity Soft Tissue Sarcoma and Bone Tumors

Vascular reconstruction using autologous vs synthetic graft for patients with extremity soft‐tissue sarcoma involving the major vessels

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