Cetinkaya Omer Arda, Celik Suleyman Utku, Kalem Mahmut, Basarir Kerem, Koksoy Cuneyt, Yildiz Huseyin Yusuf
Division of Vascular Surgery, Department of Surgery, Ankara University School of Medicine, Ankara, Turkey.
Department of Surgery, Ankara University School of Medicine, Ankara, Turkey.
Ann Vasc Surg. 2019 Apr;56:73-80. doi: 10.1016/j.avsg.2018.09.018. Epub 2018 Nov 27.
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.
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.
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.
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.
下肢软组织肉瘤（STS）的标准治疗方法是保肢手术。对于一小部分患者，可能需要同时进行血管重建，以在完全切除肿瘤并保证足够切缘的同时，保留肢体的生存能力和功能。本研究的目的是评估需要进行血管重建的肢体STS患者的手术结果和临床特征。
从2002年1月至2014年12月，13例出现血管侵犯的肢体STS患者接受了手术切除，随后进行血管重建。从前瞻性收集的临床数据库中回顾性分析患者的病历，包括人口统计学资料、组织病理学结果、并发症、血管重建的成功率以及临床和肿瘤学结果。
平均随访期为80.6个月，共进行了24次血管重建手术（1次仅动脉重建，1次仅静脉重建，11次动静脉联合重建）。对侧大隐静脉移植是血管置换的首选管道。4例患者出现5次移植血管血栓形成。2例发生动脉闭塞，3例患者的静脉旁路闭塞。动脉和静脉重建的总体五年通畅率分别为84.6%和75.2%。患者的平均生存期为105.5个月，5年无病生存率和总生存率分别为59.3%和68.4%。
对肢体STS进行血管切除和重建可以安全地进行，短期和长期的手术及肿瘤学结果均可接受。无论采用截肢手术还是保肢手术，首要重点都应是坚持严格的肿瘤学原则。此外，由于这些肿瘤的复杂性，适当的术前规划和细致的多学科方法也至关重要。
