Surgical outcomes of limb-salvage surgery with or without femoral vein reconstruction for soft tissue sarcomas of the thigh.

BACKGROUND: Limb salvage surgery for thigh soft tissue sarcomas (STSs) involving the femoral vasculature often necessitates arterial reconstruction. However, whether femoral vein reconstruction is needed remains controversial. PURPOSES: This study aimed to evaluate the outcomes of limb salvage procedures utilizing femoral vessel replacement in patients diagnosed with thigh soft tissue sarcomas involving the femoral vasculature. METHOD: We conducted a retrospective review of patients with thigh STSs who underwent limb salvage surgery and vascular reconstruction. Twelve patients were enrolled and divided into two groups on the basis of whether femoral vein was reconstructed. Five received femoral artery and vein reconstruction (group A) and seven were treated with femoral artery reconstruction alone (group B). In our cohort, vascular reconstructions were predominantly performed with prosthetic grafts due to the unavailability of suitable autologous conduits or patient preference, while only two patients received autologous venous grafts. We used the Enneking and Musculoskeletal Tumor Society (MSTS) systems to stage our patients. We assessed complications, MSTS function, local recurrence and survival. RESULTS: All patients were Enneking IIB. A wide margin excision was achieved in all patients. The great saphenous vein was preserved in group A (2/5) and group B (3/7). The mean age of the patients for group A and group B was 50.8 and 43.7 years, respectively. The median follow-up period for group A and group B was 50 months (range, 30-77 months) and 43 months (range, 24-62 months), respectively. The mean operation time of Group B was substantially less than that of group A (P<0.05). There was a significant difference in the venous embolism rate between group A(3/5) and group B in the perioperative period. No significant differences were found between the two groups in terms of hematoma formation, delayed wound healing, incision infection rate, reoperation rate, overall disease-free survival, 2-year arterial patency rate and limb salvage rate. No patient had local recurrence and one case in group B developed metastasis. The mean Musculoskeletal Tumor Society score of group A and group B at the final follow-up was 23 points and 25 points, respectively. CONCLUSIONS: Femoral arterial reconstruction alone effectively treats thigh STSs involving the femoral vasculature while femoral vein reconstruction does not significantly improve management in these cases. LEVEL OF EVIDENCE: IV.