Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
Anticancer Res. 2022 Sep;42(9):4619-4626. doi: 10.21873/anticanres.15966.
BACKGROUND/AIM: This study aimed to retrospectively investigate clinical outcomes after tumor resection surgery and discuss reconstruction methods and postoperative complications.
We analyzed the clinical outcomes, such as graft survival and prognosis, of nine patients with bone and soft-tissue tumors of the extremities with major vascular invasion who underwent limb-sparing surgery with vascular reconstruction between January 2006 and December 2020.
The primary tumor was malignant in eight cases and intermediate in one case, with a mean postoperative follow-up duration of 52.1 months. A total of 10 vascular reconstructions (arterial in eight patients and both arterial and venous in one) were performed with autologous vein grafts in four cases and synthetic grafts in five cases. Graft occlusion was observed in two cases reconstructed with the great saphenous vein measuring >200 mm in length, and the 5-year arterial patency rate was 8/9. Only one case showed local recurrence, and at 5 years, local control was achieved in eight out of nine patients. Limb-sparing was achieved in all cases and the 5-year overall and disease-free survival rates were 77.8%. Postoperative complications occurred in six patients and wound-related complications were improved by re-surgery, while the others were controlled by conservative treatment.
Limb-sparing tumor resection surgery with vascular reconstruction has favorable clinical and oncological outcomes. Most postoperative complications related to this surgery can be controlled by conservative treatment, except for wound-related complications. In reconstructions with autologous vein grafts of a length exceeding 200 mm, the graft occlusion rate may increase, and synthetic grafts may be recommended.
背景/目的：本研究旨在回顾性分析肿瘤切除术后的临床结果，并讨论重建方法和术后并发症。
我们分析了 9 例肢体血管侵犯的骨和软组织肿瘤患者的临床结果，这些患者在 2006 年 1 月至 2020 年 12 月期间接受了保肢手术和血管重建。
8 例为原发性恶性肿瘤，1 例为中级肿瘤，平均术后随访时间为 52.1 个月。共有 10 例血管重建（8 例动脉重建，1 例动静脉重建），4 例采用自体静脉移植物，5 例采用合成移植物。2 例采用大于 200mm 的大隐静脉重建的患者出现了移植物闭塞，5 年动脉通畅率为 8/9。仅 1 例出现局部复发，5 年时 9 例患者中有 8 例局部控制。所有患者均实现了保肢，5 年总生存率和无病生存率分别为 77.8%。6 例患者发生术后并发症，通过再次手术改善了与伤口相关的并发症，而其他并发症则通过保守治疗得到控制。
血管重建的保肢肿瘤切除术具有良好的临床和肿瘤学结果。除了与伤口相关的并发症外，大多数与该手术相关的术后并发症可以通过保守治疗得到控制。在采用长度超过 200mm 的自体静脉移植物进行重建时，移植物闭塞率可能会增加，此时可能建议使用合成移植物。
