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World J Orthop. May 18, 2016; 7(5): 293-300
Published online May 18, 2016. doi: 10.5312/wjo.v7.i5.293
Resection and reconstruction of pelvic and extremity soft tissue sarcomas with major vascular involvement: Current concepts
Niall P McGoldrick, Joseph S Butler, Maire Lavelle, Stephen Sheehan, Sean Dudeney, Gary C O'Toole
Niall P McGoldrick, Joseph S Butler, Sean Dudeney, Gary C O'Toole, National Sarcoma Service, Department of Trauma and Orthopaedic Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
Maire Lavelle, Department of Histopathology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
Stephen Sheehan, Department of Vascular Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: The authors declare they have no potential conflicts of interest, nor have they received any financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Niall P McGoldrick, MB, MCh, MRCSI, National Sarcoma Service, Department of Trauma and Orthopaedic Surgery, St Vincent’s University Hospital, Merrion Rd, Elm Park, Dublin 4, Ireland. niallmcg@gmail.com
Telephone: +353-1-2214000 Fax: +353-1-2214001
Received: October 15, 2015
Peer-review started: October 18, 2015
First decision: January 4, 2016
Revised: February 16, 2016
Accepted: March 7, 2016
Article in press: March 9, 2016
Published online: May 18, 2016
Processing time: 207 Days and 15.2 Hours
Abstract

Soft tissue sarcoma accounts for approximately 1% of all cancers diagnosed annually in the United States. When these rare malignant mesodermal tumours arise in the pelvis and extremities, they may potentially encase or invade large calibre vascular structures. This presents a major challenge in terms of safe excision while also leaving acceptable surgical margins. In recent times, the trend has been towards limb salvage with vascular reconstruction in preference to amputation. Newer orthopaedic and vascular reconstructive techniques including both synthetic and autogenous graft reconstruction have made complex limb-salvage surgery feasible. Despite this, limb-salvage surgery with concomitant vascular reconstruction remains associated with higher rates of post-operative complications including infection and amputation. In this review we describe the initial presentation and investigation of patients presenting with soft tissue sarcomas in the pelvis and extremities, which involve vascular structures. We further discuss the key surgical reconstructive principles and techniques available for the management of these complex tumours, drawn from our institution’s experience as a national tertiary referral sarcoma service.

Keywords: Sarcoma; Extremities; Vascular surgical procedures; Limb salvage; Reconstruction

Core tip: This paper describes the investigation and management of patients presenting with a complex soft tissue pelvic and extremity sarcomas that also compromise local vascular structures. The principles of surgical management of these cases are described in light of the most recent evidence, with examples drawn from our experience to illustrate these principles. We emphasize the importance of a multidisciplinary approach in the care of this complex patient cohort.