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Magnus L, Di Marco A, Thaveau F, Georg Y. Oncovascular Surgery for Soft-Tissue Sarcomas of the Lower Limbs with Vascular Contact: Comparison of Arterial Reconstruction and Arterial Subadventitial Dissection. Ann Vasc Surg 2024; 101:204-208. [PMID: 38307229 DOI: 10.1016/j.avsg.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/17/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Soft-tissue sarcomas represent approximately 1% of adult malignancies. When they involve the lower limbs (LLs) and come into contact with blood vessels, the therapeutic choice was historically a primary amputation. Today, radical surgical resection with wide margins of safety is the primary therapeutic option for multidisciplinary limb-salvage surgery. The aim was to compare the morbidity and mortality results of an oncologic resection of LL soft-tissue sarcomas with arterial replacement (AR) to that obtained with arterial subadventitial dissection (ASD). METHODS All consecutive patients with arterial close contact soft-tissue sarcomas of LL were included. Two groups were formed: an AR group where AR was performed following surgical resection and an ASD group in which the artery in contact with the tumor was preserved by ASD. Fisher's exact test was used. RESULTS Eighteen patients with a median age of 61.50 (interquartile range [IQR] 54.25-69.75) years underwent oncovascular surgery with orthopedic and vascular surgeons between August 2013 and May 2022. Sarcomas were all located in the thigh. Nine patients were enrolled in each of the 2 groups. The 6-month survival rate was 77.78% in the AR group and 100% in the ASD group (P = 0.4). In the AR group, 2 patients presented local recurrence, with a median recurrence-free time of 24.48 (IQR 14.08-34.87) months, and 2 patients presented distant metastases, with metastasis-free time of 13.45 (IQR 8.12-35.11) months. In the ASD group, no local recurrence was observed, and 2 patients presented metastases with a median metastasis-free time of 3.90 (IQR 3.18-4.61) months. Six patients in the AR group and 7 in the ASD group required surgical revision (P = 0.017). No major amputation was necessary. CONCLUSIONS Oncovascular surgery for LL sarcomas with ASD is certainly more locally morbid perioperatively than that with AR but provides patients with better medium-term survival.
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Affiliation(s)
- Louis Magnus
- Department of Vascular and Endovascular Surgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Antonio Di Marco
- Department of Orthopedic Surgery and Traumatology, Pôle Santé La Ligne Bleue, Épinal, France
| | - Fabien Thaveau
- Department of Vascular and Endovascular Surgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
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Zheng C, Xu G, Li W, Weng X, Yang H, Wang Z, Zhang S. Clinical outcomes after vascular reconstruction using synthetic grafts for limb salvage in patients with lower extremity sarcoma: a single-center retrospective experience. Front Oncol 2023; 13:1199556. [PMID: 37664022 PMCID: PMC10471183 DOI: 10.3389/fonc.2023.1199556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Limb-salvage surgery has become the mainstream approaches for the treatment of sarcoma in the lower extremity. In cases where the sarcoma infiltrates the primary vessel, concurrent resection of the vessels and vascular reconstruction are required to ensure sufficient resection and preservation of limb function. The objective of this study is to assess the clinical outcomes of patients who underwent vascular reconstruction utilizing synthetic grafts for limb salvage, specifically in terms of postoperative complications and limb functional status. Methods Between September 2016 and October 2021, 15 consecutive patients who underwent 15 arterial and 3 venous reconstruction procedures were included in this retrospective study. Incidence of postoperative morbidity, graft patency, rate of limb salvage, and overall survival of patients were analyzed. Results The median follow-up was 12.5 months (range, 4.5-72.0). Graft thrombosis occurred in 5 patients (33.3%) and graft occlusion occurred in 3 patients (20.0%). The median overall survival was 28.0 months with the estimated 2-year and 5-year overall survival of 57.8% and 43.4% respectively. The 1-year and 2-year estimated patency rates of arterial reconstructions were 82.3% and 62.1%, respectively. None of the included patients with limb amputation were observed as a consequence of severe vascular complications, while two patients underwent amputation due to the repeat recurrence, resulting in a limb salvage rate of 86.7%. Conclusion Our results show that the combination of vascular reconstruction and oncologic resection is a feasible option for preserving limbs in cases of musculoskeletal sarcoma with vessel involvement in the lower extremity. When vascular reconstruction surgery is performed, synthetic substitutes can be effectively used with low perioperative morbidity and an acceptable rate of limb salvage.
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Affiliation(s)
- Chuanxi Zheng
- Department of Musculoskeletal Tumor Surgery, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Gang Xu
- Department of Musculoskeletal Tumor Surgery, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Wei Li
- Department of Musculoskeletal Tumor Surgery, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xin Weng
- Department of Pathology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Hongwei Yang
- Department of Vascular Surgery, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zuhui Wang
- Department of Vascular Surgery, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Shiquan Zhang
- Department of Musculoskeletal Tumor Surgery, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
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Hauguel A, Goueffic Y, Tzanis D, Bouhadiba T, Perlbarg-Samson J, Bonvalot S, Boura B. Arterial Reconstruction for En-Bloc Resection of Soft Tissue Sarcoma: A Single Tertiary Center Experience. Ann Vasc Surg 2022:S0890-5096(22)00884-6. [PMID: 36549475 DOI: 10.1016/j.avsg.2022.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/29/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Tertiary centers recruit a number of locally advanced or recurrent soft tissue sarcomas (STSs) that require large tissue loss including vessels. Arterial reconstruction (AR) in the context of patients with cancer who may receive radiotherapy (RT) and chemotherapy (CT) is challenging. METHODS This retrospective single centre cohort study includes patients affected by extremities or trunk STS who underwent an AR during sarcoma resection, between October 2015 and February 2021 at Institut Curie. The endpoints of this study were to analyze the morbidity, the patency, and the impact on surgical margins of such associations. RESULTS Of 976 patients operated, 21 (2.15%) had AR. Seventeen (81%) had American Society of Anesthesiologists (ASA) scores ≥2. Locations were as follows: intra-abdominal n = 9 (43%), lower limb n = 8 (38%), upper limb n = 3 (14%), and cervical n = 1 (5%). N = 11 (52.3%) and n = 5 (23.8%) received RT or were operated on a preirradiated field, respectively. N = 7 (34%) patients received CT. Vein graft was used in n = 12 (57%). Musculo-cutaneous flaps were associated in n = 13 (62%) patients. Margins of resection were R0 n = 19 (90.4%), R1 n = 2, and R2 n = 0. The median follow-up was 16 months [6-44]. No postoperative death occurred. Two patients died of metastasis. At 1, 6, 12, and 24 months the primary patency was 80.9%, 71.4%, 87.5%, and 88.9%, respectively. Seven patients (33%) presented perioperative infection. Reoperation rate at 1, 6, and 12 months were 38%, 14%, and 5%, respectively. Ten patients (48%) presented persistent lymphoedema during follow-up. CONCLUSIONS AR enlarges the possibilities of STS excision with healthy margins and achieves good patency. Majority of patients were ASA ≥ 2 and received adjuvant treatments. In this particular context, morbidity is high and requires an upfront multidisciplinary management taking into account all these specific issues.
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Affiliation(s)
- Alexandra Hauguel
- Vascular center, Groupe hospitalier Paris Saint Joseph, Paris, France; LadHyX, Laboratoire d'Hydrodynamique de l'Ecole polytechnique, CNRS UMR-7646, Institut Polytechnique de Paris, Paris, France.
| | - Yann Goueffic
- Vascular center, Groupe hospitalier Paris Saint Joseph, Paris, France
| | - Dimitri Tzanis
- Department of Surgery, Institut Curie, Paris University, Paris, France
| | - Toufik Bouhadiba
- Department of Surgery, Institut Curie, Paris University, Paris, France
| | | | - Sylvie Bonvalot
- Department of Surgery, Institut Curie, Paris University, Paris, France
| | - Benoit Boura
- Vascular center, Groupe hospitalier Paris Saint Joseph, Paris, France
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Homsy P, Kantonen I, Salo J, Albäck A, Tukiainen E. Reconstruction of the superficial femoral vessels with muscle flap coverage for soft tissue sarcomas of the proximal thigh. Microsurgery 2022; 42:568-576. [PMID: 35730696 PMCID: PMC9543357 DOI: 10.1002/micr.30932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/02/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022]
Abstract
Background Surgical resection of soft tissue sarcoma with a margin of healthy tissue may necessitate resection and reconstruction of major blood vessels together with soft tissues of the proximal thigh to preserve the limb. The long‐term functional outcomes of these reconstructions remain unestablished. The aim of this report was to assess the vascular and functional outcomes of soft tissue sarcoma patients with femoral vessel reconstructions. Patients and Methods Patients who had undergone oncovascular reconstruction during the treatment of proximal thigh soft tissue sarcoma in 2014–2020 were reviewed for details of the vascular and soft tissue reconstructions, and the oncological and functional outcomes. This included eight patients of a median age 59 (range 19–77) years. All had a reconstruction of at least the superficial femoral artery and vein as well as soft tissue reconstruction with a muscle flap. All vessel reconstructions were done with either autologous vein (six grafts/four patients) or allograft (10 grafts/six patients). A microvascular latissimus dorsi flap, with a skin island, was incorporated to cover the vascular grafts in five patients. A pedicled sartorius or gracilis muscle flap was used to fill the defect in three patients. Results Graft patency was assessed in seven patients with a median follow‐up of 48 (1–76) months. The arterial graft was patent in 6/8 and the vein graft in 2/8 patients. The gait had returned to normal in five of the six patients assessed. The median MTSS was 70 (43–87)% and the TESS 90 (75–100)%. No local recurrence of the sarcoma was detected. Conclusions Vascular reconstruction combined with soft tissue reconstruction enables limb‐sparing surgery in patients with soft tissue sarcoma involving proximal femoral vessels. Although the surgeries are complex with high early morbidity, the achieved long‐term functional outcomes are worthwhile.
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Affiliation(s)
- Pauliina Homsy
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Kantonen
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juho Salo
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anders Albäck
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki Tukiainen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Kekeç AF, Günaydın İ, Öztürk R, Güngör BŞ. Outcomes of Planned Marginal and Wide Resection of Sarcomas Associated with Major Vascular Structures in Extremities. Indian J Surg Oncol 2022; 13:395-402. [DOI: 10.1007/s13193-021-01476-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
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Baram A, Ahmad BJ, Izac AY, Falah F, Sherzad H. Pediatric vascular reconstruction after trauma and malignancy; a single centere case series. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Long-term outcome in pediatric surgical bypass grafting after traumatic injury and tumor resection: retrospective cohort analysis. Sci Rep 2021; 11:16321. [PMID: 34381065 PMCID: PMC8357780 DOI: 10.1038/s41598-021-94971-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/05/2021] [Indexed: 11/15/2022] Open
Abstract
Vascular bypass surgery in children differs significantly from adults. It is a rarely performed procedure in the setting of trauma and tumor surgery. Besides technical challenges to reconstruct the small and spastic vessels, another concern in bypass grafting is the adequate limb length growth over time. The primary aim of this study was to assess long-term outcome after pediatric bypass grafting, in a single academic center, focusing on potential effects on limb development. In this retrospective cohort analyses we included all pediatric patients undergoing vascular bypass grafting at our department between 2002 and 2017. All patients ≤ 18 years suffered a traumatic injury or underwent a tumor resection of the lower or upper limb. The youngest female patient was 0.4 years, the youngest male patient was 3.5 years. During the observation period, 33 pediatric patients underwent vascular repair, whereby 15 patients underwent bypass grafting. Median overall follow-up was 4.7 years (IQR ± 9). 8 patients (53%) had a traumatic injury (traumatic surgery group) and 7 patients had a planned orthopedic tumor resection (orthopedic surgery group). In 13/15 (87%) a great saphenous vein (GSV) graft and in 2/15 (13%) a Gore-Tex graft was used for bypassing. Both Gore-Tex grafts showed complete occlusion 12 and 16 years after implantation. No patient died in the early postoperative phase (< 30 days), however 3/7 (43%) in the orthopedic group died during follow-up. Revision surgery had to be performed in 1/15 (7%) patients. A functional use of the extremity was reported in all patients. Normal limb length growth according to the contralateral site, and therefore bypass growth, could be documented in 14/15 patients. Children are surgically challenging. In our study, surgery by a specialized vascular surgery team using GSV grafts led to adequate limb length and bypass growth, and we observed no functional restrictions.
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8
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The Orthopedic-Vascular Multidisciplinary Approach Improves Patient Safety in Surgery for Musculoskeletal Tumors: A Large-Volume Center Experience. J Pers Med 2021; 11:jpm11060462. [PMID: 34073954 PMCID: PMC8225121 DOI: 10.3390/jpm11060462] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/03/2021] [Accepted: 05/20/2021] [Indexed: 12/27/2022] Open
Abstract
Objective: Wide-margin resection is mandatory for malignant bone and soft tissue tumors. However, this increases the complexity of resections, especially when vessels are involved. Patients in this high-risk clinical setting could be surgically treated using the multidisciplinary orthopedic-vascular approach. This study was carried out in this healthcare organization to evaluate patient safety in term of oncologic outcomes and reduction of the complication rate. Materials and Methods: We retrospectively reviewed 74 patients (37 males, 37 females; mean age 46 years, range 9–88) who underwent surgical excision for bone/soft tissue malignant tumors closely attached to vascular structures from October 2015 to February 2019. Vascular surgery consisted of isolation of at least one vessel (64 patients), bypass reconstruction (9 patients), and end-to-end anastomosis (1 patient). Mean follow-up was 27 months. Patients’ demographics, tumor characteristics, adjuvant treatments, type of orthopedic and vascular procedures, and oncologic and functional outcomes and complications were recorded. Results: Overall survival was 85% at 3 years follow-up. In total, 22 patients experienced at least one major complication requiring further surgery and 13 patients experienced at least one minor complication, whereas 17 reported deviations from the normal postoperative course without the need for pharmacological or interventional treatment. Major complications were higher in pelvic resections compared to limb-salvage procedures (p = 0.0564) and when surgical time was more than 4 h (p = 0.0364) at univariate analysis, whereas the most important multivariate independent predictors for major complications were pelvic resection (p = 0.0196) and preoperative radiotherapy (p = 0.0426). Conclusions: A multidisciplinary ortho-vascular approach for resection of malignant bone and soft tissue tumors tightly attached to important vascular structures should be considered a good clinical practice for patient safety.
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Berner JE, Dearden A, Magdum AA, Crowley TP, Rankin K, Clarke MJ, Ragbir M. Safety of limb-salvaging surgery for sarcomas compromising major vessels: A 15-year single-centre outcomes study. J Plast Reconstr Aesthet Surg 2021; 74:2076-2084. [PMID: 33549508 DOI: 10.1016/j.bjps.2020.12.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Limb-threatening sarcomas invading major vessels present an oncological and reconstructive challenge. Curative resection involves either performing an amputation or an immediate reconstruction of the invaded vessels. We present our 15-year experience of these cases at the North of England Bone and Soft Tissue Tumour Service. MATERIALS AND METHODS A Strengthening the Reporting of Observational studies in Epidemiology (STROBE) compliant retrospective review of our prospective database was performed including patients who required major vessel reconstruction following sarcoma excision from 2003 until 2018. Patient demographic data along with tumour and histological subtypes, treatment modality, complications and outcomes were inquired. Autologous and prosthetic vessel reconstruction approaches were compared. RESULTS Nineteen patients were identified with the most common tumour locations being the thigh and groin areas. Five cases involved recurrent tumours. Clear resection margins were obtained in 15 cases. Autologous vein grafts were preferred over polytetrafluoroethylene (PTFE) prosthesis in 17 cases. A pedicled flap or free flap was required to achieve adequate soft tissue cover in six patients, while the rest underwent primary closure. Five patients lost the patency of the reconstructed vessels with one of these requiring an amputation. The estimated disease-specific survival at 5 years was 58%. DISCUSSION Limb-preservation surgery in the context of vessel compromise is not only safe, but also a functionally and psychosocially beneficial means of avoiding an amputation. We believe that careful pre-operative planning and discussion in a multidisciplinary setting is key for obtaining positive outcomes.
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Affiliation(s)
- Juan Enrique Berner
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Kellogg College, University of Oxford, Oxford, United Kingdom.
| | - Alexander Dearden
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ashish A Magdum
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Timothy P Crowley
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Kenneth Rankin
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Michael J Clarke
- Department of Vascular Surgery, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Maniram Ragbir
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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10
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Surgical Management of Lower Limb Sarcomas. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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11
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Mlees MA, Elbarbary AH, Sallam EM. Vascular reconstruction using autologous vs synthetic graft for patients with extremity soft-tissue sarcoma involving the major vessels. J Surg Oncol 2020; 121:272-278. [PMID: 31749182 DOI: 10.1002/jso.25775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/13/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Arterial 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 METHODS Between 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. RESULTS The 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. CONCLUSIONS Graft 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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Affiliation(s)
- Mohamed A Mlees
- Surgical Oncology Unit, Department of General Surgery, Tanta University Hospitals, Tanta, Egypt
| | - Ahmed H Elbarbary
- Department of Vascular Surgery, Tanta University Hospitals, Tanta, Egypt
| | - Emad M Sallam
- Department of Vascular Surgery, Tanta University Hospitals, Tanta, Egypt
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12
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Fujiki M, Kimura T, Takushima A. Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis. Microsurgery 2020; 40:404-413. [DOI: 10.1002/micr.30553] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/26/2019] [Accepted: 12/26/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Masahide Fujiki
- Department of Plastic Surgery Kyorin University School of Medicine Tokyo Japan
| | - Takeichiro Kimura
- Department of Plastic Surgery Kyorin University School of Medicine Tokyo Japan
| | - Akihiko Takushima
- Department of Plastic Surgery Kyorin University School of Medicine Tokyo Japan
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Han A, Ahn S, Min SK. Oncovascular Surgery: Essential Roles of Vascular Surgeons in Cancer Surgery. Vasc Specialist Int 2019; 35:60-69. [PMID: 31297355 PMCID: PMC6609023 DOI: 10.5758/vsi.2019.35.2.60] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 12/23/2022] Open
Abstract
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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Affiliation(s)
- Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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14
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Ahmed F, Pounds R, Teo HG, Nevin J, Singh K, Yap J. En bloc resection of the external iliac vein along with broad ligament leiomyosarcoma: A case report. Case Rep Womens Health 2019; 23:e00131. [PMID: 31360641 PMCID: PMC6639561 DOI: 10.1016/j.crwh.2019.e00131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 10/28/2022] Open
Abstract
Outcomes following the excision of the external iliac vein during gynaecological oncology surgery are poorly documented. This is because most gynaecological oncologists consider tumours with vascular involvement inoperable. We describe a patient whose right external iliac vein was transected during the removal of a large broad ligament leiomyosarcoma invading the right external iliac vein. The patient's recovery following surgery was uneventful, and she remained disease-free 6 months postoperatively, with minimal morbidity. In describing this case, we hope to educate and inform other gynaecological oncologists facing a similar surgical challenge. We also propose that resection of the external iliac vessels in such cases is safe and feasible, and summarise the anatomical course of venous collaterals, which develop when the external iliac veins are obstructed.
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Affiliation(s)
- Fatima Ahmed
- Birmingham Women's NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2TG, UK
| | - Rachel Pounds
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Pan Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Road, B18 7QH, UK
| | - Hong-Giap Teo
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Road, B18 7QH, UK
| | - James Nevin
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Road, B18 7QH, UK
| | - Kavita Singh
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Road, B18 7QH, UK
| | - Jason Yap
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Pan Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Road, B18 7QH, UK
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15
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Cetinkaya OA, Celik SU, Kalem M, Basarir K, Koksoy C, Yildiz HY. Clinical Characteristics and Surgical Outcomes of Limb-Sparing Surgery with Vascular Reconstruction for Soft Tissue Sarcomas. Ann Vasc Surg 2018; 56:73-80. [PMID: 30500640 DOI: 10.1016/j.avsg.2018.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/25/2018] [Accepted: 09/10/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND The standard treatment for lower extremity soft tissue sarcoma (STS) is limb-sparing surgery. For a small subset of patients, concomitant vascular reconstruction may be required to preserve limb viability and function while completely excising the tumor with an adequate resection margin. The aim of this study was to evaluate the surgical outcomes and clinical characteristics of patients with STS of the extremities requiring vascular reconstructions. METHODS From January 2002 through December 2014, 13 patients with limb STS presenting with vascular invasion underwent surgical resection, followed by vascular reconstruction. The medical records such as demographics, histopathological findings, complications, success of vascular reconstruction, and clinical and oncological outcomes were retrospectively reviewed from a prospectively collected clinical database. RESULTS With a mean follow-up period of 80.6 months, a total of 24 vascular reconstruction procedures (1 only arterial, 1 only venous, and 11 both arterial and venous) were performed. Contralateral great saphenous vein graft was the conduit of choice for vascular replacement. Five graft thromboses were observed in 4 patients. Arterial occlusion occurred in two cases, and venous bypasses occluded in three patients. The overall five-year patency for arterial and venous reconstructions was 84.6% and 75.2%, respectively. The mean survival period of patients was 105.5 months, with a 5-year disease-free survival rate and overall survival rate of 59.3% and 68.4%, respectively. CONCLUSIONS Vascular resection and reconstruction for STSs of extremity can be safely performed with acceptable short- and long-term surgical and oncological outcomes. Regardless of the surgical procedure, amputation or limb-sparing surgery, the primary focus should be to adhere to strict oncological principles. In addition, because of the complexity of these tumors, an appropriate preoperative planning and meticulous multidisciplinary approach are also crucial.
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Affiliation(s)
- Omer Arda Cetinkaya
- Division of Vascular Surgery, Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Suleyman Utku Celik
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey.
| | - Mahmut Kalem
- Department of Orthopedics and Traumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Kerem Basarir
- Department of Orthopedics and Traumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Cuneyt Koksoy
- Division of Vascular Surgery, Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Huseyin Yusuf Yildiz
- Department of Orthopedics and Traumatology, Ankara University School of Medicine, Ankara, Turkey
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Bajpai J, Khanna N, Vora T, Gulia A, Laskar S, Puri A, Sanduptla B, Chinnaswamy G, Nayak P, Juvekar SL, Janu A, Desai S, Ghosh J, Purandare N, Ramadwar M, Rangarajan V, Rekhi B. Analysis of bone and soft-tissue sarcomas registered during the year 2012 at Tata Memorial Hospital, Mumbai, with clinical outcomes. Indian J Cancer 2018; 55:37-44. [PMID: 30147091 DOI: 10.4103/ijc.ijc_481_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Primary bone and soft tissue sarcomas are rare, but diagnostically and therapeutically challenging group of tumors, requiring multidisciplinary management. There are limited documented studies from multidisciplinary teams , in the form of comprehensive analysis of these tumors, from our country. This study is an analysis of cases of osteosarcomas, Ewing sarcomas (ESs), chondrosarcomas (CSs), and soft-tissue sarcomas (STSs), registered at our institution during 2012. Methods Clinical details, including outcomes of cases of bone and STSs, during the year 2012, were retrieved from the medical records of our institution and were further analyzed. Results Ninety-five high-grade, extremity-based, treatment-naïve cases of osteosarcomas were treated with a novel, dose-dense, nonhigh-dose methotrexate-based OGS-12 protocol. Good histopathologic response (necrosis ≥90%) was achieved in 59% nonmetastatic and 56% metastatic patients. At a median follow-up of 48 months, the estimated 5-year event-free survival and overall survival (OS) were 67% and 78%, respectively. In the metastatic cohort at a median follow-up of 51 months, the 5-year estimated progression-free survival was 24% and OS was 26%. Among 87 (73.2%) nonmetastatic and 32 (26.8%) metastatic, analyzable cases of ES, at a median follow-up of 40 months, the disease-free survival (DFS) and OS in the nonmetastatic group were 62% and 83%; in the metastatic group, they were 37.5% and 65.6%, respectively. Among 40 cases of CSs (33 nonmetastatic and 7 metastatic), 21 had limb salvage surgery while 5 had amputation. Microscopically, 90.4% were Grade II CSs. Five-year OS and DFS were 84.6% and 71%, respectively. Among 189 high-grade, extremity-based STSs (89% nonmetastatic), synovial sarcoma was the most common subtype (31%). Eighty-five percent had limb preservation surgery; a majority were offered adjuvant radiation with or without chemotherapy. At a median follow-up of 51 (1-63) months, 3-year local control, DFS, and OS were 81%, 48%, and 64%, respectively. Conclusions The novel OGS 12 and Ewing Family of Tumors 2001 protocols have shown comparable outcomes to international standards in cases of osteosarcoma and ES, respectively, and merit wider applications, especially in low- and middle-income countries (LMICs). Outcomes in STS and CSs were also comparable and underscore the importance of a multidisciplinary approach for the management of sarcomas in LMICS.
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Affiliation(s)
- Jyoti Bajpai
- Department of Medical Oncology, Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nehal Khanna
- Department of Radiation Oncology, Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tushar Vora
- Department of Medical Oncology, Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ashish Gulia
- Department of Surgical Oncology, Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ajay Puri
- Department of Surgical Oncology, Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Bhanupriya Sanduptla
- Trial Coordinator, Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Department of Medical Oncology, Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prakash Nayak
- Department of Surgical Oncology, Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shashikant L Juvekar
- Department of Radio Diagnosis, Bone and Soft Tissues, Disease Management Group (DMG), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Janu
- Department of Radio Diagnosis, Bone and Soft Tissues, Disease Management Group (DMG), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Subhash Desai
- Department of Radio Diagnosis, Bone and Soft Tissues, Disease Management Group (DMG), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Bone and Soft Tissues, Disease Management Group (DMG), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Department of Surgical Pathology, Bone and Soft Tissues, Disease Management Group (DMG), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Bone and Soft Tissues, Disease Management Group (DMG), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Surgical Pathology, Bone and Soft Tissues, Disease Management Group (DMG), Tata Memorial Hospital, Mumbai, Maharashtra, India
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Akgül T, Sormaz İC, Aksoy M, Uçar A, Özger H, Eralp L. Results and functional outcomes of en-bloc resection and vascular reconstruction in extremity musculoskeletal tumors. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:409-414. [PMID: 30274704 PMCID: PMC6318543 DOI: 10.1016/j.aott.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/14/2018] [Accepted: 08/29/2018] [Indexed: 01/28/2023]
Abstract
Objectives This paper aims to evaluate the extremity function and vascular outcome after limb-sparing surgery for extremity musculoskeletal tumors invading vascular structure required reconstruction. Methods Of 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. Results The 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%. Conclusion Limb-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 evidence Level IV, Therapeutic study
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Affiliation(s)
- Turgut Akgül
- Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul, Turkey.
| | - İsmail Cem Sormaz
- Department of General Surgery, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Murat Aksoy
- Department of General Surgery, Bahcesehir University, Liv Hospital, Istanbul, Turkey.
| | - Adem Uçar
- Department of Radiology, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Harzem Özger
- Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Levent Eralp
- Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul, Turkey.
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Okamoto K, Koga A, Tazume H, Noguchi R, Kumamoto S, Satoh H, Sueyoshi T, Fukui T. Early and Mid-Term Outcomes after Vascular Reconstruction for Patients with Lower-Extremity Soft-Tissue Malignant Tumors. Ann Vasc Dis 2018; 11:228-232. [PMID: 30116416 PMCID: PMC6094028 DOI: 10.3400/avd.oa.18-00027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: To evaluate limb-salvage surgery including vascular resection for lower-extremity soft-tissue sarcomas and carcinomas for adult patients. Materials and Methods: Eight consecutive patients (median age, 59 years) who underwent vascular replacement during surgery for malignant tumors in the lower limbs between November 2006 and March 2018 were evaluated. Patient data were retrospectively obtained in a computerized database. Arterial and venous reconstructions were performed for seven patients, with one additional patient receiving venous reconstruction only. Autologous-vein (n=6) and synthetic bypasses were used for arterial repairs, whereas only autologous veins were implanted for venous repairs. Results: Morbidity was 62.5%, and in-hospital mortality was 12.5%. At a median follow-up of 24 months, the primary patency rates of arterial and venous reconstructions were 85.7% and 62.5%, respectively. Limb salvage was achieved in all cases. Conclusion: Early and mid-term bypass patency rates, the high percentage of limb salvage, and the oncologic outcome underline the efficacy of en bloc resection of soft-tissue tumors involving major vessels of the lower limbs. The anticipated need for vascular resection and reconstruction should not be a contraindication to sarcoma and carcinoma resections. However, efforts to achieve better control over systemic spread are required for long-term survival.
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Affiliation(s)
- Ken Okamoto
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Ayumi Koga
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Hirokazu Tazume
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryo Noguchi
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Sayahito Kumamoto
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Hiroo Satoh
- Department of Orthopedic Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Takanao Sueyoshi
- Department of Orthopedic Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
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Teixeira LEM, Leão TM, Regazzi DB, Soares CBG. Risco de amputação após procedimento de revascularização nas ressecções de sarcoma. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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20
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Teixeira LEM, Leão TM, Regazzi DB, Soares CBG. Amputation risk after the revascularization procedures in sarcoma resections. Rev Bras Ortop 2017; 52:714-719. [PMID: 29234656 PMCID: PMC5720856 DOI: 10.1016/j.rboe.2017.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/30/2016] [Indexed: 01/27/2023] Open
Abstract
Objective The objective of this study is to evaluate the efficacy of vascular reconstructive surgery after resection of bone and soft tissue tumors in extremities and the risk of progression to amputation. Methods This is a retrospective, observational data collection from medical records of patients who underwent resection of bone and soft tissue tumors in the period of 2002–2015. Thirteen patients met the inclusion criteria, which evaluated the correlations between certain factors (gender, tumor type, location, reconstruction, revascularization and patency, infection) with amputation in the postoperative period. Results In this study, of the 13 patients undergoing reconstruction, five (38.46%) evolved to amputation. All patients who progressed to amputation had the following in common: presence of bone sarcoma (p = 0.005), having undergone reconstruction with an orthopedic prosthesis (p = 0.005), lack of vascular patency in the revascularization site in the postoperative period (p = 0.032), and surgical site infection (p = 0.001). None of the patients with soft tissue sarcoma underwent amputation, and the only patient with bone sarcoma who did not undergo amputation had no infection and maintained vascular patency of the graft. Conclusion The occurrence of infection appears to be one of the main risk factors for failure of revascularization, especially in cases of bone sarcoma in which vascular reconstruction is performed with placement of a non-conventional joint prosthesis.
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Affiliation(s)
- Luiz Eduardo Moreira Teixeira
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Belo Horizonte, MG, Brazil.,Hospital Madre Teresa, Serviço de Ortopedia e Traumatologia, Belo Horizonte, MG, Brazil
| | - Thiago Marques Leão
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Belo Horizonte, MG, Brazil
| | - Daniel Barbosa Regazzi
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Belo Horizonte, MG, Brazil
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Wortmann M, Alldinger I, Böckler D, Ulrich A, Hyhlik-Dürr A. Vascular reconstruction after retroperitoneal and lower extremity sarcoma resection. Eur J Surg Oncol 2017; 43:407-415. [DOI: 10.1016/j.ejso.2016.10.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/16/2016] [Accepted: 10/31/2016] [Indexed: 12/17/2022] Open
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Davis LA, Dandachli F, Turcotte R, Steinmetz OK. Limb-sparing surgery with vascular reconstruction for malignant lower extremity soft tissue sarcoma. J Vasc Surg 2017; 65:151-156. [DOI: 10.1016/j.jvs.2016.05.094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/26/2016] [Indexed: 10/20/2022]
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23
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McGoldrick NP, Butler JS, Lavelle M, Sheehan S, Dudeney S, O'Toole GC. Resection and reconstruction of pelvic and extremity soft tissue sarcomas with major vascular involvement: Current concepts. World J Orthop 2016; 7:293-300. [PMID: 27190757 PMCID: PMC4865719 DOI: 10.5312/wjo.v7.i5.293] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/16/2016] [Accepted: 03/07/2016] [Indexed: 02/06/2023] Open
Abstract
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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Poultsides GA, Tran TB, Zambrano E, Janson L, Mohler DG, Mell MW, Avedian RS, Visser BC, Lee JT, Ganjoo K, Harris EJ, Norton JA. Sarcoma Resection With and Without Vascular Reconstruction: A Matched Case-control Study. Ann Surg 2015; 262:632-40. [PMID: 26366542 PMCID: PMC4657732 DOI: 10.1097/sla.0000000000001455] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the impact of major vascular resection on sarcoma resection outcomes. SUMMARY BACKGROUND DATA En bloc resection and reconstruction of involved vessels is being increasingly performed during sarcoma surgery; however, the perioperative and oncologic outcomes of this strategy are not well described. METHODS Patients undergoing sarcoma resection with (VASC) and without (NO-VASC) vascular reconstruction were 1:2 matched on anatomic site, histology, grade, size, synchronous metastasis, and primary (vs. repeat) resection. R2 resections were excluded. Endpoints included perioperative morbidity, mortality, local recurrence, and survival. RESULTS From 2000 to 2014, 50 sarcoma patients underwent VASC resection. These were matched with 100 NO-VASC patients having similar clinicopathologic characteristics. The rates of any complication (74% vs. 44%, P = 0.002), grade 3 or higher complication (38% vs. 18%, P = 0.024), and transfusion (66% vs. 33%, P < 0.001) were all more common in the VASC group. Thirty-day (2% vs. 0%, P = 0.30) or 90-day mortality (6% vs. 2%, P = 0.24) were not significantly higher. Local recurrence (5-year, 51% vs. 54%, P = 0.11) and overall survival after resection (5-year, 59% vs. 53%, P = 0.67) were similar between the 2 groups. Within the VASC group, overall survival was not affected by the type of vessel involved (artery vs. vein) or the presence of histology-proven vessel wall invasion. CONCLUSIONS Vascular resection and reconstruction during sarcoma resection significantly increases perioperative morbidity and requires meticulous preoperative multidisciplinary planning. However, the oncologic outcome appears equivalent to cases without major vascular involvement. The anticipated need for vascular resection and reconstruction should not be a contraindication to sarcoma resection.
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Affiliation(s)
| | - Thuy B. Tran
- Division of Surgical Oncology, Department of Surgery, Stanford University
| | | | | | | | - Matthew W. Mell
- Division of Vascular Surgery, Department of Surgery, Stanford University
| | | | - Brendan C. Visser
- Division of Surgical Oncology, Department of Surgery, Stanford University
| | - Jason T. Lee
- Division of Vascular Surgery, Department of Surgery, Stanford University
| | - Kristen Ganjoo
- Division of Oncology, Department of Medicine, Stanford University
| | - E. John Harris
- Division of Vascular Surgery, Department of Surgery, Stanford University
| | - Jeffrey A. Norton
- Division of Surgical Oncology, Department of Surgery, Stanford University
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Nishinari K, Krutman M, Aguiar Junior S, Pignataro BS, Yazbek G, Zottele Bomfim GA, Teivelis MP, Wolosker N. Surgical outcomes of vascular reconstruction in soft tissue sarcomas of the lower extremities. J Vasc Surg 2015; 62:143-9. [DOI: 10.1016/j.jvs.2015.02.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/01/2015] [Indexed: 01/27/2023]
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Moutinho M, Silva E, Amorim P, Freitas H, Evangelista A, Fernandes e Fernandes J. Tratamento cirúrgico de um leiomiossarcoma do membro inferior. ANGIOLOGIA E CIRURGIA VASCULAR 2015. [DOI: 10.1016/j.ancv.2015.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gronchi A, Olmi P, Casali PG. Combined modalities approach for localized adult extremity soft-tissue sarcoma. Expert Rev Anticancer Ther 2014; 7:1135-44. [DOI: 10.1586/14737140.7.8.1135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Planned preservation surgery for soft tissue sarcomas adjacent to critical structures. Arch Orthop Trauma Surg 2013; 133:481-6. [PMID: 23381296 DOI: 10.1007/s00402-013-1690-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Whether to preserve or sacrifice critical structures (bone, major vessels and major nerves) adjacent to soft tissue sarcomas is still controversial. Referring to characteristic imaging and intraoperative findings, we perform planned preservation surgery for these critical structures. The aim of this study was to investigate the clinical outcome of soft tissue sarcomas adjacent to critical structures and to validate this procedure. METHODS Of 202 cases of soft tissue sarcomas surgically treated at our department of orthopedic surgery from 2004 to 2010, 57 cases (28 %) whose tumors were adjacent to the critical structures were studied. There were 36 men and 21 women. In 32 cases critical structures were preserved, and in 25 resected together with the tumor. The oncological outcome and histological surgical margin were analyzed. RESULTS The overall survival and local recurrence-free survival rates at 5 years were 75.9 and 83.2 %. In 26 of the 32 (81 %) preserved cases histologically the surgical margin was negative, and in 17 (53 %) radiotherapy could be avoided. Neither overall survival (p = 0.9669) nor local recurrence-free survival (p = 0.7819) differed significantly between two groups. CONCLUSIONS When soft tissue sarcomas are located adjacent to bone or major vessels, by meticulously detaching the periosteum or neurovascular sheath referring to characteristic imaging and intraoperative findings, a histologically negative surgical margin can be achieved in the majority, allowing avoidance of postoperative radiotherapy. Planned preservation surgery provided no significant adverse effect on survival or local recurrence rates, validating this procedure.
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Vascular reconstruction for limb preservation during sarcoma surgery: A case series and a management algorithm. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013. [DOI: 10.1016/j.recote.2013.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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31
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Viñals Viñals JM, Gomes Rodrigues TA, Perez Sidelnikova D, Serra Payro JM, Palacin Porté JA, Higueras Suñe C. [Vascular reconstruction for limb preservation during sarcoma surgery: a case series and a management algorithm]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012; 57:21-6. [PMID: 23594979 DOI: 10.1016/j.recot.2012.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the results of vascular reconstruction in soft tissue sarcoma surgery and establish an algorithm based on current evidence. MATERIAL AND METHODS We studied patients undergoing soft-tissue sarcoma in a tertiary hospital. A retrospective review of 8 cases was carried out, analysing the demographics, surgical planning, complications, disease-free survival and bypass patency. RESULTS Successful limb preservation was observed in all patients, and the bypass remained patent in all cases. The mean follow-up was 38.4 months average, with 87.5% survival and no recurrences. CONCLUSIONS The involvement of major vascular structures in soft tissue sarcomas of the limbs does not necessarily exclude resectability. In selected cases, resection is possible with vascular reconstruction and limb preservation. However, multidisciplinary planning is needed.
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Affiliation(s)
- J M Viñals Viñals
- Servicio de Cirugía Plástica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Surgery with vascular reconstruction for soft-tissue sarcomas in the inguinal region: oncologic and functional outcomes. Ann Vasc Surg 2012; 26:693-9. [PMID: 22664282 DOI: 10.1016/j.avsg.2011.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 11/29/2011] [Accepted: 12/06/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Treatment of soft-tissue sarcomas involving the inguinal region remains challenging because of difficulties in achieving wide surgical margins due to anatomical features. The study aimed to analyze the oncologic and functional outcomes of wide resection with vascular reconstruction for inguinal soft-tissue sarcomas. METHODS Three men and seven women were treated for inguinal soft-tissue sarcomas by wide surgical resection with vascular reconstruction. RESULTS Arteries and veins were replaced in nine patients, and artery replacement alone was carried out in one patient. Femoral nerve resections were performed in six patients. One patient and five patients developed local recurrence and distant metastases, respectively. Limb salvage was achieved in 9 of 10 patients (90%). Six patients and one patient developed vascular (arterial graft occlusion [n = 1], lymphedema [n = 5]) and nonvascular (hematoma [n = 1]) complications, respectively. Five-year arterial primary patency was 77%. Five-year disease-free and overall survival rates were 45% and 77%, respectively. Functional outcome scores at latest follow-up averaged 87.5% for Musculoskeletal Tumor Society 1993. CONCLUSIONS En-bloc resection of major critical structures along with tumor and vascular reconstructions using synthetic grafts is a feasible option in limb salvage surgery for inguinal soft-tissue sarcomas.
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Ghosh J, Bhowmick A, Baguneid M. Oncovascular surgery. Eur J Surg Oncol 2011; 37:1017-24. [PMID: 21917411 DOI: 10.1016/j.ejso.2011.08.131] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 05/11/2011] [Accepted: 08/22/2011] [Indexed: 01/31/2023] Open
Affiliation(s)
- J Ghosh
- Department of Vascular Surgery, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Greater Manchester, UK.
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Steinau HU, Daigeler A, Langer S, Steinsträsser L, Hauser J, Goertz O, Lehnhardt M. Limb salvage in malignant tumors. Semin Plast Surg 2010; 24:18-33. [PMID: 21286302 PMCID: PMC2887000 DOI: 10.1055/s-0030-1253240] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Limb-sparing resection and reconstruction has become the treatment of choice in extremity malignancies, as amputation does not provide better long-term survival rates or functional advantages. R0 resection, the removal of the tumor in sano, remains the prerequisite and most important oncologic parameter to avoid local recurrence. Successful treatment requires the combination of surgical eradication and the patient's specific functional and aesthetic rehabilitation. Our clinical rationale resulting from more than 2000 cases will be demonstrated. The problematic aspects of different tumor entities and the locoregional clearance of lymphatic pathways will be discussed. Differential diagnosis and multimodality treatment in high-volume tumor centers is likely to achieve superior oncologic statistics. Long-term survivors after microsurgical reconstructions and possible secondary malignancies will be addressed.
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Affiliation(s)
- Hans-Ulrich Steinau
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Adrien Daigeler
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Stefan Langer
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Lars Steinsträsser
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Jörg Hauser
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Ole Goertz
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
| | - Markus Lehnhardt
- Department of Plastic Surgery and Burns, Sarcoma Reference Center, BG–University Hospital “Bergmannsheil,” Ruhr-University, Bochum, Germany
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Mahendra A, Gortzak Y, Ferguson PC, Deheshi BM, Lindsay TF, Wunder JS. Management of vascular involvement in extremity soft tissue sarcoma. Recent Results Cancer Res 2009; 179:285-299. [PMID: 19230547 DOI: 10.1007/978-3-540-77960-5_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Advances in adjuvant treatment protocols and improvements in imaging techniques have helped improve the limb-salvage rate for extremity soft tissue sarcomas to approximately 95%. Moreover, improvements in operative techniques have enabled successful limb-salvage surgery to be performed even in the face of vascular invasion or encasement by tumor. En bloc resection of major vascular structures with the tumor and reconstruction with reversed saphenous vein grafts, femoral venous grafts, or synthetic grafts has proved to be a feasible option in limb-salvage surgery. However, the surgical oncologist and patient should be aware that although overall function is only slightly worse after these procedures, individual functional results are less predictable. In addition, procedures requiring vascular resection and reconstruction are associated with an increased risk of complications, including amputation.
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Affiliation(s)
- Ashish Mahendra
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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Misra A, Mistry N, Grimer R, Peart F. The management of soft tissue sarcoma. J Plast Reconstr Aesthet Surg 2008; 62:161-74. [PMID: 19036655 DOI: 10.1016/j.bjps.2008.08.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 07/14/2008] [Accepted: 08/12/2008] [Indexed: 11/19/2022]
Abstract
SUMMARY Soft tissue sarcomas are a rare group of mesenchymal tumours that display cardinal signs, which can raise suspicion to their diagnosis. Management in a sarcoma treatment centre by its multidisciplinary team has improved outcome. Good local disease control with limb salvage and adjuvant radiotherapy has considerably reduced the morbidity of previous limb amputation. By the early involvement of a plastic surgeon, tissue reconstruction is optimised and wound complications reduced. This article looks at the contemporary management of soft tissue sarcoma and, in particular, its relevance to the plastic surgeon today.
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Affiliation(s)
- A Misra
- Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
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Abstract
This article discusses the treatment of adult soft tissue sarcoma (excluding gastrointestinal stromal tumor), analyzing the principles underlying treatment and the results of surgery, radiotherapy, and chemotherapy. The focus is on the European approach in particular, and ongoing studies are summarized.
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