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Outcomes Of Onco-vascular Reconstruction In Patients With Extremity Sarcomas
Anita Zahiri1, Arash Fereydooni, MD MS MHS
1, Emily Eshraghian, MPH
1, Milan Ho, BS
2, Raffi S. Avedian, MD
3, David G. Mohler, MD
3, Jason T. Lee, MD
1, E. John Harris, MD
1, Elizabeth L. George, MD MSc
1.
1Division of Vascular and Endovascular Surgery, Stanford University School of Medicine, Palo Alto, CA, USA,
2UT Southwestern Medical School, Dallas, TX, USA,
3Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
OBJECTIVESWhile surgical resection is the primary treatment for patients with sarcomas due to chemoradiation resistance, the feasibility of these procedures is challenged by involvement of critical vasculature. Given the small scale of prior studies and overall paucity of research, we aimed to describe long-term outcomes of these joint procedures.
METHODSA retrospective chart review of patients with extremity sarcomas who underwent surgical resection with vascular reconstruction at a tertiary referral center between 2001-2024.
RESULTS Fifty vascular interventions (30 arterial/20 venous; 86% lower extremity) were performed during tumor resection in 25 patients (mean age (SD) 44.4 (21) years; 52% female). Half (48%) were for recurrent disease, 64% had prior chemoradiation, and 30% had stage 4 disease. The most common pathologies were synovial sarcoma (16%) and chondrosarcoma (16%). Despite a Clavien-Dindo grade II+ complication rate of 76%, there were no mortalities within 30 days. However, three patients experienced graft thrombosis within 30 days, requiring reintervention (2 open, 1 endovascular) to regain patency - one of those patients underwent major amputation due to ischemia severity. Median overall survival was 5.3 years with 20% experiencing local recurrence, 16% distant metastases, and 28% with both. During the follow-up period (median 805 days [IQR: 325, 1918]), there were no further amputations or vascular graft infections. Vascular reintervention-free survival at 1 year was 90.5% (Figure 1). Five patients (20%) underwent vascular reintervention beyond 30-days (4 open, 1 endovascular): two required vascular reconstruction for local recurrence and three for assisted primary patency. Dacron/PTFE conduits of the iliac, femoral, and popliteal arteries had 100% patency during follow-up, as did femoral vein reconstruction with autologous conduits. Femoral vein reconstruction with cryopreserved conduits had a 1-year assisted primary patency of 66.7%. Femoral artery reconstruction with GSV/femoral vein demonstrated 85.7% assisted primary patency at 1 year and 75% at 4 years.
CONCLUSIONSThis study highlights promising outcomes of vascular reconstruction in patients with extremity sarcomas. Overall, extremity arterial reconstructions following tumor resection had excellent patency and durability. Despite the complexity and high rates of post-operative complications, the low failure-to-rescue rate reflects the importance of multidisciplinary teamwork in caring for these high-acuity patients.
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