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Oncovascular Surgery-The Multidisciplinary Approach: Surgical Resection of the Musculoskeletal Tumor and Associated Revascularization

Author(s): Ascoli Marchetti Andrea, Di Giulio Lorenzo, Citoni Gianluca, Ippoliti Arnaldo

Introduction: The possibility of preserving the limb during the definitive removal operation in the case of sarcoma is a goal pursued in a multidisciplinary perspective. The aim of the study is to report our experience gained in collaboration with the IFO oncology orthopedic division and with the operating units of Orthopedics A and B of the Tor Vergata Policlinico, reporting the results and complications of the procedures performed.

Methods: From 2011 to 2014, 30 patients treated had primitive and secondary musculoskeletal neoplasm with a mean age of 44 years (14-67 years) in 26 cases (86.6%) were required revascularization. Women accounted for 53.84% (14/26), 46.16% were men (12/26). The preoperative study included a biopsy of the lesion and ultrasonography and angio-CT with multiplanar reconstructions for the evaluation of the vascular anatomy and neoplasia extension.

Results: The average postoperative follow-up was 19.4 months. The reconstruction of the vessels has been implemented in 12/26 (46%) mainly using the autologous saphenous contralateral vein. The use of the prosthesis was performed in the others cases (with PTFE and Dacron K prosthesis). In 4 cases the patients had lower limb edema, with a distance venous patency of 80% and arterial patency of 100%. We had no mortality at 30 days. Two patients underwent VAC therapy. No amputations had at 30 days. In 14 patients were perform chemotherapy or radiotherapy before and after surgery.

Conclusions: A long-term evaluation is needed to determine the implications at distance. In case of involvement of arterial and venous vessels, vascular surgery skills allow radical resection and function preservation. The mortality gap depends by the prognosis of neoplasm.

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