Extended indications for functional limb-sparing surgery in extremity sarcoma using complex reconstruction
I. B. Paz, L. D. Wagman, J. J. Terz, B. Chandrasekhar, J. A. Lorant, G. M. Moscarello and T. Odom-Maryon
Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, Calif. 91010.
From 1980 to 1991, 29 patients underwent complex reconstruction following
extremity sarcoma resection. Soft tissue was the site of origin in 15
patients (52%) and bone was the site of origin in 14 patients (48%), with
20 sarcomas (69%) in the lower extremity. Resection consisted of the
following procedures: extended anatomical soft-tissue resections (21
patients [72%]), bone resections (18 patients [62%]), and joint resections
(14 patients [48%]). Reconstruction involved the following: myocutaneous
flaps (20 patients [69%]), joint prosthesis (eight patients [28%]), and
bone reconstruction (15 patients [52%]). There was no surgical mortality;
one patient required an amputation owing to surgical complications. The
site of the first failure was local (four [31%] of 13 patients), lung (five
patients [38%]), others (four patients [31%]). At a median follow-up of 23
months, 18 patients (62%) had no evidence of disease, 27 (93%) had no local
disease, 21 (72%) had good extremity function, three (10%) had major
disabilities, and five (17%) underwent amputations. Local control improved
when the margin of resection was larger than 10 mm. Disease-free survival
was 67% at 3 years. Overall survival was 51% at 5 years. Tumor size was an
independent predictor of overall survival. Local recurrence did not affect
overall survival.
