Clinical Outcomes of Limb-sparing Tumor Surgery With Vascular Reconstruction for Bone and Soft-tissue Tumors

Abstract

Background/Aim: This study aimed to retrospectively investigate clinical outcomes after tumor resection surgery and discuss reconstruction methods and postoperative complications. Patients and Methods: 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. Results: 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. Conclusion: 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.