VASCULAR RECONSTRUCTION FOR LIMB SALVAGE IN SARCOMA OF THE LOWER-EXTREMITY

Objectives: To examine the patency and limb-salvage characteristics of vascular reconstruction in patients with sarcomas of the lower extrem ity who had been treated with limb-preserving resection and to examine patient survival during a long follow-up period. Design: Retrospectiv e cohort study. Setting: University hospital, tertiary referral center . Patients: From 1984 to 1992, 14 patients underwent limb-preserving r esection of sarcomas in the proximal lower extremity, with 20 vascular reconstructions performed. Outcome Measures: Color Doppler scans docu mented patency of the vascular reconstructions. Clinical evaluation in cluded functional results in terms of limb movement and quality of lif e. Local tumor control and systemic recurrence were examined by repeat ed radiologic examination. Overall survival as well as time and cause of death were assessed. Results: A total of 13 patients had patent vas cular grafts, while the venous graft became occluded in 1 patient. Lim b function was rated as excellent or good in 9 patients, as fair in 3, as poor in 1, and could not be clinically estimated in 1. Postoperati ve thrombosis of the venous graft was detected in 3 patients and was e ffectively managed by thrombectomy in 2. Three patients underwent reop eration because of hematoma or complications caused by local infection . The tumor endoprosthesis had to be replaced in 3 patients. During fo llow-up periods that ranged from 15 to 132 months (mean, 55 months), 4 patients died. In all of these patients the cause of death was system ic recurrence in the lung. Two additional patients developed pulmonary metastases, but at the time of this report, they were still alive as long as 132 months after operative resection or chemotherapy. No local recurrence was found. Conclusion: Limb-preserving resection of sarcom a of the lower extremity can be performed with satisfactory function o f the limb maintained, even if it becomes necessary to resect the femo ral vessels. Autologous venous graft for vascular reconstruction is th e treatment of choice. In spite of the high incidence of metastases, c onsiderable long-term survival is possible.