Results and functional outcomes of en-bloc resection and vascular reconstruction in extremity musculoskeletal tumors

Abstract

ObjectivesThis paper aims to evaluate the extremity function and vascular outcome after limb-sparing surgery for extremity musculoskeletal tumors invading vascular structure required reconstruction.MethodsOf the 507 patients with musculoskeletal tumors, who underwent surgery between 2004 and 2007, 17 (3,3%) patients with major vessel involvement were included in the study. The mean age was 37.8 ± 14.5, with a female/male ratio of 8/9. Thirteen (76.4%) patients had Stage IIb disease, and 2 (11,7%) patients had Stage III disease. In 2 (11,7%) patients have locally aggressive tumor that had Stage 3. Fifteen (88.2%) of the cases involved lower extremity, whilst 2 (11.8%) of them involved upper extremity. An arterial reconstruction was carried out in all patients. Wide tumor resection and endoprosthetic reconstruction were performed in 6 (35.2%) patients. Other 11 (65.8%) patients were treated with wide resection and soft tissue reconstruction. Postoperative data included; perioperative morbidities such as bleeding, infection, graft thrombosis, rupture, metastatic local recurrence and mortality. Ankle brachial index (ABI) and color-flow-duplex-scan (CFDS) were done at the final follow-up of the study, in order to prove the efficacy of reconstruction. Functional outcome was evaluated with International Society of Limb Salvage (ISOLS) criteria.ResultsThe mean follow-up was of 39 months (range 3–120). Perioperative complications were arterial graft thrombosis occurred in 3 (17.6%) patients treated acutely with thrombectomy, uncontrolled deep wound infection occurred in 2 patients whom extremities were amputated.The most frequent complication after surgery was limb edema according to possibly venous and lymphatic obstruction, staged as C1, C2 and C3 disease was established in 6 patients (two patients in each group), and 1 patient was classified as C6 disease. Three (17.6%) patients had local recurrence (1/3 patient died and 2/3 (11.7%) patients underwent transfemoral amputation). At the last follow-up, 9 (52.9%) patients were alive without evidence of disease, 8 (47.1%) patients were died due to primary disease. There were 8 (47.1%) patients alive with an intact limb. Although functional outcome scores were satisfactory, emotional acceptance scores were low. The limb salvage probability was 74.0%.ConclusionLimb-sparing oncological surgery in musculoskeletal tumors with vascular invasion provides a satisfactory limb function, which may lead to an improved life quality. Arterial reconstruction has a high rate of patency in the long term. The surgeon should be aware of early perioperative complication related to vascular reconstruction and infection that effect on the rate of extremity survival.Level of evidenceLevel IV, Therapeutic study

The Orthopedic-Vascular Multidisciplinary Approach Improves Patient Safety in Surgery for Musculoskeletal Tumors: A Large-Volume Center Experience

“…They found no statistically significant difference of function between the group with vascular reconstructions (mean score, 78.5%) and the group without vascular reconstructions (mean score, 82.2%) [ 37 ]. Other authors reported similar results with respect function in sarcoma patients with resection and vascular reconstructions (mean score, 70%–80% [ 12 , 31 , 38 , 39 ]. In the present study, we did not evaluate the function of the patients because data on parameters of function were not available for the majority of the patients.…”

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

“…Anticoagulation therapy followed by vascular reconstruction was reported in 14 studies (Adelani et al, 2007;Akgül et al, 2018;Baxter et al, 2007;Bonardelli et al, 2000;Emori et al, 2012;Ghert et al, 2005;Kawai et al, 1996;Koperna et al, 1996;Muramatsu et al, 2011;Nishinari et al, 2015;Schwarzbach et al, 2005;Spark et al, 2009;Tsukushi et al, 2008;Umezawa et al, 2013). Use of anticoagulation regimens varied widely across the studies, with 10 studies reporting intraoperative and postoperative use of heparin or lowmolecular-weight heparin.…”

Oncovascular Surgery-The Multidisciplinary Approach: Surgical Resection of the Musculoskeletal Tumor and Associated Revascularization

“…No infections were observed in our experience Table 1. A multidisciplinary setting is crucial for the radicality of the surgery [12][13][14][15] (Figures 1-2).…”