Limb-Saving Surgery with Vascular Reconstruction in Lower Extremity Soft Tissue Sarcoma

There is uncertainty in the literature as to whether major vessel involvement in extremity soft tissue sarcomas constitutes an indication for amputation. This study includes fifteen patients with lower extremity soft tissue sarcomas who under¬went major vessel resection and reconstruction in the context of limb preservation for soft tissue sarcoma.Purpose: To review the impact of vascular graft replacement following en bloc resection of soft tissue sarcoma (STS) invading major lower extremity vascular structure on short term outcomes as regard limb-salvage rate.Methods: Between September 2005 and September 2008, 15 consecutive patients with STS of the lower limb with vascular invasion were investigated, operated and followed up in Vascular Surgery Unit and Department of Clinical Oncology Nuclear Medicine, Mansoura University Hospital and were followed up for a period ranged from 3-36 months with mean of 13 months and a life table analysis was con¬structed for patency of arterial grafts and for the limb salvage rate.Results: 15 patients (12 males and 3 females) aged between 16-57 years had vascular replacement grafts (11 ePTFE, 2 saphenous vein graft) for arterial reconstruction and 3 vascular replacement grafts (2 ePTFE, 1 saphenous vein graft) for venous reconstruction. Life table analysis for arterial construction showed primary patency rate of 73.85% at 10 months and 64.6% at the end of study and limb salvage rate of 86.7% at last follow-up visit.Conclusion: Malignant vascular infiltration should not be a barrier for wide local excision for STS patients despite malignant vascular invasion of lower extremity and patients can avoid amputation after careful selection of patients.