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Hagi T, Nakamura T, Nagano A, Koike H, Yamada K, Aiba H, Fujihara N, Wasa J, Asanuma K, Kozawa E, Ishimura D, Kawanami K, Izubuchi Y, Shido Y, Sudo A, Nishida Y. Clinical outcome in patients who underwent amputation due to extremity soft tissue sarcoma: Tokai Musculoskeletal Oncology Consortium study. Jpn J Clin Oncol 2021; 52:157-162. [PMID: 34875695 DOI: 10.1093/jjco/hyab184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Soft tissue sarcomas are a diverse group of rare malignant tumours, mostly occurring in the lower extremities. Amputations are necessary for achieving local control when the soft tissue sarcomas are too large and/or have neurovascular involvement. Patients who require amputation have a poorer prognosis than those who undergo limb-salvage surgery. PATIENTS AND METHODS We investigated the tumour characteristics and the clinical outcomes in 55 patients with primary soft tissue sarcomas, who underwent amputation. We excluded patients with amputation performed distal to the wrist or ankle joints and those with recurrent soft tissue sarcomas. RESULTS The mean tumour size was 11.1 cm. Hip disarticulation was performed in 6 patients, 20 underwent above the knee amputation, 8 underwent knee disarticulation and 12 underwent below the knee amputation. Shoulder disarticulation was performed in three patients, five underwent above the elbow amputation, and one underwent below the elbow amputation. The 5-year disease-specific survival rate was 52.8%. The 5-year recurrence-free survival rate and 5-year metastasis-free survival rates were 90.1% and 38.5%, respectively. Larger tumour size, age and the distant metastases at first presentation were predictors of poor prognosis for survival in multivariate analysis. Twenty-eight patients could walk using artificial limbs. The level of amputation (above versus below the knee) showed a significant difference in achieving independent gait. CONCLUSION Amputation is a useful treatment option for achieving local control in patients with large soft tissue sarcomas. Patients had an opportunity of walking, especially for those who underwent below the knee amputation.
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Affiliation(s)
- Tomohito Hagi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University, Gifu, Japan
| | - Hiroshi Koike
- Department of Orthopaedic Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Kenji Yamada
- Department of Orthopaedic Oncology, Okazaki City Hospital, Okazaki, Japan
| | - Hisaki Aiba
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nasa Fujihara
- Division of Orthopaedic Surgery, Aichi Cancer Centre Hospital, Nagoya, Japan
| | - Junji Wasa
- Division of Orthopaedic Oncology, Shizuoka Cancer Centre Hospital, Shizuoka, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eiji Kozawa
- Department of Orthopaedic Surgery, Nagoya Memorial Hospital, Nagoya, Japan
| | - Daisuke Ishimura
- Department of Orthopaedic Surgery, Fujita Medical University, Nagoya, Japan
| | - Katsuhisa Kawanami
- Department of Orthopaedic Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yuya Izubuchi
- Department of Orthopaedic Surgery, Fukui University Graduate School of Medicine, Fukui, Japan
| | - Yoji Shido
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Hospital, Nagoya, Japan.,Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
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Intraarterial ultrasound in pancreatic cancer: feasibility study and preliminary results. Cardiovasc Intervent Radiol 2010; 33:726-31. [PMID: 20440500 DOI: 10.1007/s00270-010-9871-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 01/20/2010] [Indexed: 01/26/2023]
Abstract
Despite technological advances in computed tomography (CT) and magnetic resonance imaging, the involvement of the celiac or mesenteric artery in pancreatic cancer remains uncertain in many cases. Infiltration of these vessels is important in making decisions about therapy choices but often can only be definitively determined through laparotomy. Local (intraarterial) ultrasound may increase diagnostic accuracy. Using the Volcano intravascular ultrasound (IVUS) system, we applied a transfemoral method to scan the celiac and mesenteric arteries directly intraarterial. This technique was used in five patients with suspected pancreatic cancer. Technical success was achieved in all cases. In one case, a short dissection of the mesenteric artery occurred but could be managed interventionally. In tumors that did not contact with the vessels, IVUS was unable to display the tissue pathology. Our main interest was the infiltration of the arteries. In one case, infiltration was certain in the CT scan but uncertain in two patients. In the latter two cases, IVUS correctly predicted infiltration in one and freedom from tumor in the other case. In our preliminary study, IVUS correctly predicted arterial infiltration in all cases. IVUS did not provide new information when the tumor was far away from the vessel. Compared with IVUS in the portal vein, the information about the artery is more detailed, and the vessel approach is easier. These results encouraged us to design a prospective study to evaluate the sensitivity and specificity of this method.
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Hohenberger P, Schwarzbach MHM. Management of locally recurrent soft tissue sarcoma after prior surgery and radiation therapy. Recent Results Cancer Res 2009; 179:271-283. [PMID: 19230546 DOI: 10.1007/978-3-540-77960-5_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Surgery and radiation therapy are the standard for local tumour control in the treatment of soft tissue sarcoma. Sarcoma recurrence within a previously irradiated area is one of the most problematic therapeutic challenges in soft tissue tumours. Any information on previous therapy needs to be available in detail. In case of recurrent sarcoma not amenable to surgical resection with wide and clear margins, a multimodality therapy needs to be applied. The armamentarium usually looks for a neoadjuvant downstaging of the sarcoma by radiotherapy, chemo-radiotherapy or isolated limb perfusion with all of those strategies bearing benefits, but also specific risks. The potential of repeated radiotherapy and the modality that can be used (intraoperative radiotherapy, brachytherapy) needs to be carefully evaluated. The pathologist saves these major problems in intraoperative frozen section histology or resection margins and thus needs to be aware of the type of cancer cells potentially present within the resection specimen. Plastic and reconstructive surgery to cover the area of re-resection with viable and well-v tissue is absolutely crucial to prevent lymphatic fistula. Thus, adequate treatment of those specific situations usually involves postoperative physiotherapy and a specific rehabilitation, which is extremely important.
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Affiliation(s)
- Peter Hohenberger
- Divison of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Hospital Mannheim, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany.
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Mahendra A, Gortzak Y, Ferguson PC, Deheshi BM, Lindsay TF, Wunder JS. Management of vascular involvement in extremity soft tissue sarcoma. Recent Results Cancer Res 2009; 179:285-299. [PMID: 19230547 DOI: 10.1007/978-3-540-77960-5_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Advances in adjuvant treatment protocols and improvements in imaging techniques have helped improve the limb-salvage rate for extremity soft tissue sarcomas to approximately 95%. Moreover, improvements in operative techniques have enabled successful limb-salvage surgery to be performed even in the face of vascular invasion or encasement by tumor. En bloc resection of major vascular structures with the tumor and reconstruction with reversed saphenous vein grafts, femoral venous grafts, or synthetic grafts has proved to be a feasible option in limb-salvage surgery. However, the surgical oncologist and patient should be aware that although overall function is only slightly worse after these procedures, individual functional results are less predictable. In addition, procedures requiring vascular resection and reconstruction are associated with an increased risk of complications, including amputation.
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Affiliation(s)
- Ashish Mahendra
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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