Outcomes of Planned Marginal and Wide Resection of Sarcomas Associated with Major Vascular Structures in Extremities

Ahmet Fevzi Kekeç; İlknur Günaydın; Recep Öztürk; Bedii Şafak Güngör

doi:10.1007/s13193-021-01476-5

Outcomes of Planned Marginal and Wide Resection of Sarcomas Associated with Major Vascular Structures in Extremities

Indian J Surg Oncol. 2022 Jun;13(2):395-402. doi: 10.1007/s13193-021-01476-5. Epub 2021 Nov 22.

Authors

Ahmet Fevzi Kekeç¹, İlknur Günaydın², Recep Öztürk³, Bedii Şafak Güngör³

Affiliations

¹ Meram Faculty of Medicine, Department of Orthopaedics and Traumatology, Necmettin Erbakan University, Konya, Turkey.
² Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
³ Department of Orthopaedics and Traumatology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Demetevler Mahallesi, Vatan Cad., Yenimahalle, Ankara, 06200 Turkey.

Abstract

Bone and soft tissue sarcomas of lower and upper extremities may sometimes be in close contact with neurovascular structures. In such cases, it is controversial that whether en bloc resection and vascular reconstruction to reach wider surgical margins or planned marginal resection with the help of adjuvant therapies should be preferred. This study aimed to determine surgical and oncological outcomes of planned marginal and wide resection of extremity sarcomas that are associated with major vascular structures in the extremities. The collected database of 54 patients treated by the same orthopedic and vascular surgeon for primary or locally recurrent soft and bone tissue sarcoma of extremities was retrospectively reviewed. Eligible subjects for this study were patients diagnosed with upper and lower extremity soft and bone tissue sarcomas that encased a maximum of 50% of the circumference of the major vascular structures, requiring limb-sparing resection. When microscopic positive (19 patients, 33.9%) and negative cases' (35 patients, 66.1%) surgical margins were compared, local recurrence, metastasis, amputation, and tumor type (soft/bone) parameters showed no statistically significant difference. When metastatic and non-metastatic patients were compared, it was shown that bone tumors metastasized more than soft tissue tumors (p = 0.001). However, there was no difference between metastasis and amputation, histopathology, grade, nerve involvement, surgical margins, or local recurrences. The mean survival was 1460.6 ± 137.4 days, and the 6-year mortality was 87.5%. Anesthetic and surgical complication rates may be higher since en bloc resection surgeries of large tumors with vascular reconstructions take a very long time. Therefore, we suggest marginal resection with sub-adventitial dissection in those locations and wide resection at other areas according to the surgeon's experiences about safe margin with the contribution of radiotherapy.

Keywords: Extremity sarcomas; Limb salvage; Musculoskeletal tumor; Vascular invasion; Vascular reconstruction.