Zheng Chuanxi, Xu Gang, Li Wei, Weng Xin, Yang Hongwei, Wang Zuhui, Zhang Shiquan
Department of Musculoskeletal Tumor Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
Department of Pathology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
Front Oncol. 2023 Aug 17;13:1199556. doi: 10.3389/fonc.2023.1199556. eCollection 2023.
Limb-salvage surgery has become the mainstream approaches for the treatment of sarcoma in the lower extremity. In cases where the sarcoma infiltrates the primary vessel, concurrent resection of the vessels and vascular reconstruction are required to ensure sufficient resection and preservation of limb function. The objective of this study is to assess the clinical outcomes of patients who underwent vascular reconstruction utilizing synthetic grafts for limb salvage, specifically in terms of postoperative complications and limb functional status.
Between September 2016 and October 2021, 15 consecutive patients who underwent 15 arterial and 3 venous reconstruction procedures were included in this retrospective study. Incidence of postoperative morbidity, graft patency, rate of limb salvage, and overall survival of patients were analyzed.
The median follow-up was 12.5 months (range, 4.5-72.0). Graft thrombosis occurred in 5 patients (33.3%) and graft occlusion occurred in 3 patients (20.0%). The median overall survival was 28.0 months with the estimated 2-year and 5-year overall survival of 57.8% and 43.4% respectively. The 1-year and 2-year estimated patency rates of arterial reconstructions were 82.3% and 62.1%, respectively. None of the included patients with limb amputation were observed as a consequence of severe vascular complications, while two patients underwent amputation due to the repeat recurrence, resulting in a limb salvage rate of 86.7%.
Our results show that the combination of vascular reconstruction and oncologic resection is a feasible option for preserving limbs in cases of musculoskeletal sarcoma with vessel involvement in the lower extremity. When vascular reconstruction surgery is performed, synthetic substitutes can be effectively used with low perioperative morbidity and an acceptable rate of limb salvage.
保肢手术已成为治疗下肢肉瘤的主流方法。当肉瘤侵犯主要血管时，需要同时切除血管并进行血管重建，以确保充分切除肿瘤并保留肢体功能。本研究的目的是评估采用人工血管进行血管重建保肢患者的临床结局，特别是术后并发症和肢体功能状态。
在2016年9月至2021年10月期间，本回顾性研究纳入了15例连续接受15次动脉和3次静脉重建手术的患者。分析患者术后发病率、人工血管通畅率、保肢率和总生存率。
中位随访时间为12.5个月（范围4.5 - 72.0个月）。5例患者（33.3%）发生人工血管血栓形成，3例患者（20.0%）发生人工血管闭塞。中位总生存期为28.0个月，估计2年和5年总生存率分别为57.8%和43.4%。动脉重建的1年和2年估计通畅率分别为82.3%和62.1%。纳入的患者均未因严重血管并发症而截肢，2例患者因肿瘤复发而接受截肢，保肢率为86.7%。
我们的结果表明，血管重建与肿瘤切除相结合是下肢肌肉骨骼肉瘤侵犯血管时保肢的可行选择。进行血管重建手术时，人工血管替代品可有效使用，围手术期发病率低，保肢率可接受。
