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Management of Vascular Involvement in Extremity Soft Tissue Sarcoma

  • Chapter
Treatment of Bone and Soft Tissue Sarcomas

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 179))

Abstract

Advances in adjuvant treatment protocols and improvements in imaging techniques have helped improve the limb-salvage rate for extremity soft tissue sarcomas to approximately 95%. Moreover, improvements in operative techniques have enabled successful limb-salvage surgery to be performed even in the face of vascular invasion or encasement by tumor. En bloc resection of major vascular structures with the tumor and reconstruction with reversed saphenous vein grafts, femoral venous grafts, or synthetic grafts has proved to be a feasible option in limb-salvage surgery. However, the surgical oncologist and patient should be aware that although overall function is only slightly worse after these procedures, individual functional results are less predictable. In addition, procedures requiring vascular resection and reconstruction are associated with an increased risk of complications, including amputation.

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References

  • Adelani MA, Holt GE, Dittus RS, Passman MA, Schwartz HS (2007) Revascularization after seg-mental resection of lower extremity soft tissue sarcomas. J Surg Oncol 95:455–460

    Article  PubMed  Google Scholar 

  • Baxter BT, Mahoney C, Johnson PJ, Selmer KM, Pipinos II, Rose J, Neff JR (2007) Concomitant arterial and venous reconstruction with resection of lower extremity sarcomas. Ann Vasc Surg 21:272–279

    Article  PubMed  Google Scholar 

  • Bell CL, Ali AT, Brawley JG, D'Addio VJ, Modrall JG, Valentine RJ, Clagett GP (2005) Arterial reconstruction of infected femoral artery pseu-doaneurysms using superficial femoral-popliteal vein. J Am Coll Surg 200:831–836

    Article  PubMed  Google Scholar 

  • Bickels J, Wittig JC, Kollender Y, Kellar-Graney K, Malawer MM, Meller I (2002) Sciatic nerve resection: is that truly an indication for amputation? Clin Orthop Relat Res 399:201–204

    Article  PubMed  Google Scholar 

  • Bonardelli S, Nodari F, Maffeis R, Ippolito V, Saccalani M, Lussardi L, Giulini S (2000) Limb salvage in lower extremity sarcomas and technical details about vascular reconstruction. J Orthop Sci 5:555–560

    Article  PubMed  CAS  Google Scholar 

  • Brooks AD, Gold JS, Graham D, Boland P, Lewis JJ, Brennan MF, Healey JH (2002) Resection of the sciatic, peroneal, or tibial nerves: assessment of functional status. Ann Surg Oncol 9:41–47

    Article  PubMed  CAS  Google Scholar 

  • Cardozo MA, Frankini AD, Bonamigo TP (2002) Use of superficial femoral vein in the treatment of infected aortoiliofemoral prosthetic grafts. Cardiovasc Surg 10:304–310

    Article  PubMed  CAS  Google Scholar 

  • Carmody BJ, Arora S, Avena R, Curry KM, Simpkins J, Cosby K, Sidawy AN (1999) Accelerated carotid artery disease after high-dose head and neck radiotherapy: is there a role for routine carotid duplex surveillance? J Vasc Surg 30:1045–1051

    Article  PubMed  CAS  Google Scholar 

  • Clarkson PW, Griffin AM, Catton CN, O'Sullivan B, Ferguson PC, Wunder JS, Bell RS (2005) Epineural dissection is a safe technique that facilitates limb salvage surgery. Clin Orthop Relat Res 438:92–96

    Article  PubMed  Google Scholar 

  • Davis AM, Sennik S, Griffin AM, Wunder JS, O'Sullivan B, Catton CN, Bell RS (2000) Predictors of functional outcomes following limb salvage surgery for lower-extremity soft tissue sarcoma. J Surg Oncol 73:206–211

    Article  PubMed  CAS  Google Scholar 

  • Davis AM, O'Sullivan B, Bell RS, Turcotte R, Catton CN, Wunder JS, Chabot P, Hammond A, Benk V, Isler M, Freeman C, Goddard K, Bezjak A, Kandel RA, Sadura A, Day A, James K, Tu D, Pater J, Zee B (2002) Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol 20:4472–4477

    Article  PubMed  CAS  Google Scholar 

  • Davis AM, O'Sullivan B, Turcotte R, Bell R, Catton C, Chabot P, Wunder J, Hammond A, Benk V, Kandel R, Goddard K, Freeman C, Sadura A, Zee B, Day A, Tu D, Pater J; Canadian Sarcoma Group; NCI Canada Clinical Trial Group Randomized Trial (2005) Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol 75:48–53

    Article  PubMed  Google Scholar 

  • Dorresteijn LD, Kappelle AC, Scholz NM, Munneke M, Scholma JT, Balm AJ, Bartelink H, Boogerd W (2005) Increased carotid wall thickening after radiotherapy on the neck. Eur J Cancer 41:1026–1030

    Article  PubMed  Google Scholar 

  • Dorweiler B, Neufang A, Schmiedt W, Oelert H (2001) Autogenous reconstruction of infected arterial prosthetic grafts utilizing the superficial femoral vein. Thorac Cardiovasc Surg 49:107–111

    Article  PubMed  CAS  Google Scholar 

  • Fortner JG, Kim DK, Shiu MH (1977) Limb-preserving vascular surgery for malignant tumors of the lower extremity. Arch Surg 112:391–394

    PubMed  CAS  Google Scholar 

  • Fuchs B, Davis AM, Wunder JS, Bell RS, Masri BA, Isler M, Turcotte R, Rock MG (2001) Sciatic nerve resection in the thigh: a functional evaluation. Clin Orthop Relat Res 34–41

    Article  PubMed  Google Scholar 

  • Gerrand CH, Wunder JS, Kandel RA, O'Sullivan B, Catton CN, Bell RS, Griffin AM, Davis AM (2001) Classification of positive margins after resection of soft-tissue sarcoma of the limb predicts the risk of local recurrence. J Bone Joint Surg Br 83:1149–1155

    Article  PubMed  CAS  Google Scholar 

  • Ghert MA, Davis AM, Griffin AM, Alyami AH, White L, Kandel RA, Ferguson P, O'Sullivan B, Catton CN, Lindsay T, Rubin B, Bell RS, Wunder JS (2005) The surgical and functional outcome of limb-salvage surgery with vascular reconstruction for soft tissue sarcoma of the extremity. Ann Surg Oncol 12:1102–1110

    Article  PubMed  Google Scholar 

  • Hohenberger P, Allenberg JR, Schlag PM, Reichardt P (1999) Results of surgery and multimodal therapy for patients with soft tissue sarcoma invading to vascular structures. Cancer 85:396–408

    Article  PubMed  CAS  Google Scholar 

  • Hünerbein M, Hohenberger P, Stroszczynski C, Bartelt N, Schlag PM, Tunn PU (2007) Resection of soft tissue sarcoma of the lower limb after evaluation of vascular invasion with intraopera-tive intravascular ultrasonography. Br J Surg 94:168–173

    Article  PubMed  Google Scholar 

  • Kawai A, Hashizume H, Inoue H, Uchida H, Sano S (1996) Vascular reconstruction in limb salvage operations for soft tissue tumors of the extremities. Clin Orthop Relat Res 332:215–222

    Article  PubMed  Google Scholar 

  • Kooby DA, Antonescu CR, Brennan MF, Singer S (2004) Atypical lipomatous tumor/well-differentiated liposarcoma of the extremity and trunk wall: importance of histological subtype with treatment recommendations. Ann Surg Oncol 11:78–84

    Article  PubMed  Google Scholar 

  • Koperna T, Teleky B, Vogl S, Windhager R, Kainberger F, Schatz KD, Kotz R, Polterauer P (1996) Vascular reconstruction for limb salvage in sarcoma of the lower extremity. Arch Surg 131:1103–1107

    PubMed  CAS  Google Scholar 

  • Kubo T, Sugita T, Shimose S, Arihiro K, Ochi M (2006) Conservative surgery for well-differentiated liposarcomas of the extremities adjacent to major neurovascular structures. Surg Oncol 15:167–171

    Article  PubMed  Google Scholar 

  • Leggon RE, Huber TS, Scarborough MT (2001) Limb salvage surgery with vascular reconstruction. Clin Orthop Relat Res 387:207–216

    Article  PubMed  Google Scholar 

  • Martin JD, Buckley AR, Graeb D, Walman B, Salvian A, Hay JH (2005) Carotid artery stenosis in asymptomatic patients who have received unilateral head-and-neck irradiation. Int J Radiat Oncol Biol Phys 63:1197–1205

    PubMed  Google Scholar 

  • Matsushita M, Kuzuya A, Mano N, Nishikimi N, Sakurai T, Nimura Y, Sugiura H (2001) Sequelae after limb-sparing surgery with major vascular resection for tumor of the lower extremity. J Vasc Surg 33:694–699

    Article  PubMed  CAS  Google Scholar 

  • McKay A, Motamedi M, Temple W, Mack L, Moore R (2007) Vascular reconstruction with the superficial femoral vein following major oncologic resection. J Surg Oncol 96:151–159

    Article  PubMed  Google Scholar 

  • Meyerson SL, Feldman T, Desai TR, Leef J, Schwartz LB, McKinsey JF (2002) Angiographic access site complications in the era of arterial closure devices. Vasc Endovascular Surg 36:137–144

    Article  PubMed  Google Scholar 

  • Nishinari K, Wolosker N, Yazbek G, Zerati AE, Nishimoto IN (2006a) Venous reconstructions in lower limbs associated with resection of malignancies. J Vasc Surg 44:1046–1050

    Article  Google Scholar 

  • Nishinari K, Wolosker N, Yazbek G, Zerati AE, Nishimoto IN, Puech-Leão P (2006b) Arterial reconstructions associated with the resection of malignant tumors. Clinics 61:339–344

    Article  Google Scholar 

  • O'Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, Wunder J, Kandel R, Goddard K, Sadura A, Pater J, Zee B (2002) Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 359:2235–2241

    Article  PubMed  Google Scholar 

  • Phifer TJ, Gerlock AJ Jr, Vekovius WA, Rich NM, McDonald JC (1984) Amputation risk factors in concomitant superficial femoral artery and vein injuries. Ann Surg 199:241–243

    Article  PubMed  CAS  Google Scholar 

  • Rich NM (1982) Principles and indications for primary venous repair. Surgery 91:492–496

    PubMed  CAS  Google Scholar 

  • Schwarzbach MH, Hormann Y, Hinz U, Bernd L, Willeke F, Mechtersheimer G, Böckler D, Schumacher H, Herfarth C, Büchler MW, Allenberg JR (2005) Results of limb-sparing surgery with vascular replacement for soft tissue sarcoma in the lower extremity. J Vasc Surg 42:88–97

    Article  PubMed  Google Scholar 

  • Swerdlow AJ, Higgins CD, Smith P, Cunningham D, Hancock BW, Horwich A, Hoskin PJ, Lister A, Radford JA, Rohatiner AZ, Linch DC (2007) Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. J Natl Cancer Inst 99:206–214

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK

    Ashish Mahendra

  2. University Musculoskeletal Oncology Unit, Mount Sinai Hospital, 476-600 University Avenue, Toronto, ON M5G 1X5, Canada

    Yair Gortzak, Peter C. Ferguson, Benjamin M. Deheshi & Jay S. Wunder

  3. Division of Vascular Surgery, University Health Network, 190 Elizabeth St., Toronto, ON M5G 2C4, Canada

    Thomas F. Lindsay

Authors
  1. Ashish Mahendra
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  2. Yair Gortzak
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  3. Peter C. Ferguson
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  4. Benjamin M. Deheshi
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  5. Thomas F. Lindsay
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  6. Jay S. Wunder
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Editor information

Editors and Affiliations

  1. Leiter Department Tumororthopädie Klinik für Orthopädie und Orthopädische Rheumatologie, HELIOS-Klinikum Berlin, Schwanebecker Chaussee 50, Berlin, 13125

    Per-Ulf Tunn

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© 2009 Springer-Verlag Berlin Heidelberg

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Mahendra, A., Gortzak, Y., Ferguson, P.C., Deheshi, B.M., Lindsay, T.F., Wunder, J.S. (2009). Management of Vascular Involvement in Extremity Soft Tissue Sarcoma. In: Tunn, PU. (eds) Treatment of Bone and Soft Tissue Sarcomas. Recent Results in Cancer Research, vol 179. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-77960-5_18

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  • DOI: https://doi.org/10.1007/978-3-540-77960-5_18

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-77959-9

  • Online ISBN: 978-3-540-77960-5

  • eBook Packages: MedicineMedicine (R0)

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