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The Surgical and Functional Outcome of Limb-Salvage Surgery With Vascular Reconstruction for Soft Tissue Sarcoma of the Extremity

¹ University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 476E, Toronto, Ontario, Canada M6B 1H9
² Research, Toronto Rehabilitation Institute, University of Toronto, 550 University Avenue, Toronto, Ontario, Canada M5G 2A2
³ Surgical Oncology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9
⁴ Department of Diagnostic Imaging, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5
⁵ Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5
⁶ Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9
⁷ Division of Vascular Surgery, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4

Correspondence: Address correspondence and reprint requests to: Jay S. Wunder, MD, MSc, FRCSC; E-mail: wunder{at}mshri.on.ca.

Background: This study compared the surgical, oncological, and functional outcomes of patients undergoing limb-salvage surgery for extremity soft tissue sarcoma with vascular resection and reconstruction with the outcomes of those undergoing limb-salvage without vascular reconstruction.

Methods: Nineteen patients were identified from a prospective soft-tissue sarcoma database who underwent vascular resection and reconstruction as part of their limb-salvage surgery and who were followed up for at least 1 year or until death. Each of these 19 patients was case-matched to 2 additional patients on the basis of tumor location, size, and depth; patient age; and timing of radiation. To compare functional outcome, a subset of patients was case-matched with additional criteria including wound-complication status, motor nerve sacrifice, similar preoperative function as determined by the Toronto Extremity Salvage Score, and no metastases at diagnosis or the 1-year follow-up.

Results: Patients in the vascular reconstruction group were more likely to require a muscle transfer (53% vs. 18%; P = .008), experience a wound complication (68% vs. 32%; P = .03), experience deep venous thrombosis (26% vs. 0; P = .003), experience significant limb edema (87% vs. 20%; P = .001), and ultimately require an amputation (16% vs. 3%; P = .07). Patients who underwent vascular reconstruction had only slightly lower Toronto Extremity Salvage Score scores 1 year after surgery (78.5 vs. 84.2; P = .35). There were no significant differences in local or systemic tumor relapse between the two groups.

Conclusions: Vascular reconstruction is a feasible option in limb-salvage surgery for soft tissue sarcoma but is associated with an increased risk for postoperative complications, including amputation. Although function is not significantly worse after vascular reconstruction, the results are less predictable.

Key Words: Sarcoma • Vascular reconstruction • Function • Complications • Limb salvage