Results and functional outcomes of en-bloc resection and vascular reconstruction in extremity musculoskeletal tumors

Objectives: This paper aims to evaluate the extremity function and vascular outcome after limb-sparingsurgery for extremity musculoskeletal tumors invading vascular structure required reconstruction.Methods: Of the 507 patients with musculoskeletal tumors, who underwent surgery between 2004 and2007, 17 (3,3%) patients with major vessel involvement were included in the study. The mean age was37.8 ± 14.5, with a female/male ratio of 8/9. Thirteen (76.4%) patients had Stage IIb disease, and 2 (11,7%)patients had Stage III disease. In 2 (11,7%) patients have locally aggressive tumor that had Stage 3. Fifteen(88.2%) of the cases involved lower extremity, whilst 2 (11.8%) of them involved upper extremity. Anarterial reconstruction was carried out in all patients. Wide tumor resection and endoprostheticreconstruction were performed in 6 (35.2%) patients. Other 11 (65.8%) patients were treated with wideresection and soft tissue reconstruction. Postoperative data included; perioperative morbidities such asbleeding, infection, graft thrombosis, rupture, metastatic local recurrence and mortality. Ankle brachialindex (ABI) and color-flow-duplex-scan (CFDS) were done at the final follow-up of the study, in order toprove the efficacy of reconstruction. Functional outcome was evaluated with International Society ofLimb Salvage (ISOLS) criteria.Results: The mean follow-up was of 39 months (range 3e120). Perioperative complications were arterialgraft thrombosis occurred in 3 (17.6%) patients treated acutely with thrombectomy, uncontrolled deepwound infection occurred in 2 patients whom extremities were amputated.The most frequent complication after surgery was limb edema according to possibly venous andlymphatic obstruction, staged as C1, C2 and C3 disease was established in 6 patients (two patients in eachgroup), and 1 patient was classified as C6 disease. Three (17.6%) patients had local recurrence (1/3 patientdied and 2/3 (11.7%) patients underwent transfemoral amputation). At the last follow-up, 9 (52.9%)patients were alive without evidence of disease, 8 (47.1%) patients were died due to primary disease.There were 8 (47.1%) patients alive with an intact limb. Although functional outcome scores weresatisfactory, emotional acceptance scores were low. The limb salvage probability was 74.0%.Conclusion: Limb-sparing oncological surgery in musculoskeletal tumors with vascular invasion providesa satisfactory limb function, which may lead to an improved life quality. Arterial reconstruction has ahigh rate of patency in the long term. The surgeon should be aware of early perioperative complicationrelated to vascular reconstruction and infection that effect on the rate of extremity survival.