Surgical outcomes of vascular reconstruction in soft tissue sarcomas of the lower extremities

Background Limb-sparing procedures are currently considered the standard treatment for lower limb soft tissue sarcoma (STS). Surgical excision combined with vascular resection may be necessary to provide an adequate safety margin and to improve the oncologic outcomes. In this scenario, vascular reco...

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Bibliographic Details
Published in:Journal of vascular surgery 2015-07, Vol.62 (1), p.143-149
Main Authors: Nishinari, Kenji, MD, PhD, Krutman, Mariana, MD, Aguiar Junior, Samuel, MD, PhD, Pignataro, Bruno Soriano, MD, Yazbek, Guilherme, MD, PhD, Zottele Bomfim, Guilherme Andre, MD, Teivelis, Marcelo Passos, MD, Wolosker, Nelson, MD, PhD
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - mortality
Brazil
Feasibility Studies
Female
Graft Occlusion, Vascular - etiology
Graft Occlusion, Vascular - physiopathology
Humans
Kaplan-Meier Estimate
Limb Salvage
Lower Extremity - blood supply
Male
Middle Aged
Predictive Value of Tests
Reconstructive Surgical Procedures - adverse effects
Reconstructive Surgical Procedures - mortality
Retrospective Studies
Risk Factors
Saphenous Vein - physiopathology
Saphenous Vein - transplantation
Sarcoma - mortality
Sarcoma - pathology
Sarcoma - surgery
Soft Tissue Neoplasms - mortality
Soft Tissue Neoplasms - pathology
Soft Tissue Neoplasms - surgery
Surgery
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Patency
Young Adult
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Summary:Background Limb-sparing procedures are currently considered the standard treatment for lower limb soft tissue sarcoma (STS). Surgical excision combined with vascular resection may be necessary to provide an adequate safety margin and to improve the oncologic outcomes. In this scenario, vascular reconstruction is required to preserve limb function. We evaluated the long-term patency and survival outcomes of arterial and venous reconstruction after resecting lower limb STS in the largest single-center case series to date. Methods Between November 1995 and July 2014, 25 patients with lower limb STS and vascular invasion underwent surgical resection followed by arterial or venous reconstruction. Patients were followed up at regular outpatient visits, at which clinical examinations and duplex ultrasound mapping were performed to assess graft patency. Results A total of 44 revascularization procedures were performed. The median follow-up time for the arterial and venous groups combined was 25.2 months (range, 0.26-225.6 months). The 5-year survival probability was 42.1%. The graft occlusion rate was significantly higher after reconstruction with synthetic grafts than after reconstruction with saphenous vein substitutes ( P  = .02). The occlusion rate was not significantly different between arterial reconstruction and venous reconstruction ( P > .05). Conclusions Arterial and venous reconstruction is feasible after surgical resection of lower limb STS. Vascular reconstruction provides favorable long-term patency outcomes and low complication rates, allowing limb preservation and disease control in a select group of patients. Vascular reconstruction using venous grafts had a significantly higher patency rate than reconstruction with artificial venous substitutes.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2015.02.004