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

Surgical outcomes of limb-salvage surgery with or without femoral vein reconstruction for soft tissue sarcomas of the thigh | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Surgical outcomes of limb-salvage surgery with or without femoral vein reconstruction for soft tissue sarcomas of the thigh Wenquan Xu, Jinxin Hu, Xiaojun Zhu, Tao Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6932024/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Dec, 2025 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 12 You are reading this latest preprint version Abstract 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 aims to evaluate the outcomes of limb salvage procedures utilizing femoral vessel replacement in patients who 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 is reconstructed. 5 received femoral artery and vein reconstruction (group A) and 7 were treated with femoral artery reconstruction alone (group B). 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 of group A and group B were 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 is 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 1 case in group B developed metastasis. The mean Musculoskeletal Tumor Society score of group A and group B at the final follow-up were 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 Lower extremities Soft tissue sarcoma Femoral vessel replacement Limb-salvage surgery Complications Figures Figure 1 Figure 2 Introduction Sarcomas have a low incidence, accounting for less than 1% of all malignant tumors[ 1 ]. It can occur throughout the body, with 50% of cases occurring in the extremities[ 2 ]. Among these, 5–10% involve major blood vessels[ 3 ]. Traditionally, the usual treatment option for sarcomas that affect the major blood arteries of the lower extremities is amputation to ensure a tumor-free margin. However, limb salvage has emerged as the primary therapeutic option for lower extremity malignant tumors as a result of the accessibility of contemporary surgical techniques[ 4 , 5 ]. Meanwhile, for social or psychological reasons, a large number of patients refuse amputation[ 6 ]. For soft tissue sarcomas (STSs) of the thigh that compromise major blood vessels, The procedure consists of tumor and vital vascular resection, followed by segmental vascular reconstruction. At present, the main surgical techniques for vascular reconstruction after soft tissue sarcoma (STSs) resection include artificial blood vessel reconstruction and autologous vascular transplantation[ 7 , 8 ]. However, whether femoral vein reconstruction is needed remains controversial. In this study, we retrospectively reviewed the outcomes of patients with STSs who underwent limb salvage surgery at our hospital to evaluate the necessity of femoral vein reconstruction. Patients and methods The inclusion criteria for patients were as follows: (I) Patients with primary or recurrent soft tissue sarcoma of the thigh; (II) A diagnosis of thigh STSs was confirmed through pathological examination; (III) Imaging shows that the tumor encases or invades the femoral blood vessels; (IV) Patients with a strong desire for limb salvage. Every patient or their legal guardian provided informed consent. Between May 2017 and October 2021, twelve patients with thigh STSs were treated with en bloc excision and vascular reconstruction. The histological diagnosis was confirmed preoperatively via needle biopsy under ultrasound guidance for newly diagnosed patients. Imaging examinations, such as MRI scan of the lesion, CT scan of the chest and whole body bone scan, were performed after a clinical diagnosis to evaluate the tumor mass, soft-tissue involvement, infiltration of surrounding tissues, and margins of resection. All of the tumors were staged according to Enneking system. Restaging was undertaken after two to three pre-operative cycles at three weeks intervals if necessary. All procedures were performed by a single senior surgeon. Prior to surgery, all patients underwent Doppler ultrasonography of the lower limbs to assess the vascular status of both sides. Treatment and rehabilitation The thigh STSs and the affected femoral artery and vein were separated from the surrounding normal tissues. The vessels were occluded with vascular clamps. The tumor component, the affected vasculature and the nearby muscles were resected in an en bloc fashion. The length and diameter of the damaged vessels were measured to choose appropriate artificial blood vessel or autologous great saphenous veins. All patients received anti-inflammatory, anticoagulant, and volume expansion therapies postoperatively. All patients received subcutaneous injections of low molecular weight heparin (6000 units) after the drainage tube was removed. After discharge, the patients were usually prescribed oral rivaroxaban tablets (15 mg, bid) for three months and aspirin (100 mg, qd) for an additional three months. Evaluation Age, gender, tumor location, histological type, transplant type, and other patient details were documented. Early and late surgical complications, vascular occlusion rate, and the reoperations rate were the primary outcomes. The functional outcomes were assessed via the MSTS Scoring System. Follow-up The patients were clinically and radiologically (MRI) examined every three months for signs of infection and local recurrence for the next two years following surgery, and then every six months after that. To detect pulmonary metastases, a chest CT scan was performed every three months in the first two years and then every six months thereafter. Doppler ultrasound in lower limb is used to assess vascular patency every three months. The patients' radiological and clinical records were examined retrospectively. Functional assessments were made according to the Musculoskeletal Tumor Society (MSTS) Scoring System[ 9 ] 6 months after surgery. The time to patency was calculated in months from the date of operation to vessel occlusion. Statistical analysis All the statistical analyses were performed via Microsoft Excel (Microsoft, Washington, USA) and SPSS software (IBM, New York, USA). Categorical variables are expressed as counts (percentages), whereas continuous variable data are expressed as mean ± standard deviation. Fisher’s exact test was used to investigate associations between categorical variables. Primary patency and disease-free survival were estimated via the Kaplan-Meier technique. For all the statistical tests, a 5% significance level was employed. Results Demographics Twelve consecutive patients with STSs of the thigh underwent en bloc excision and vascular reconstruction at our department. Five patients received femoral artery and vein reconstruction (group A), and seven patients were treated with femoral artery reconstruction alone (group B). One patient from group A and two patients from group B underwent vascular reconstruction with autologous veins, whereas the other patients underwent artificial vascular replacement. Synovial sarcoma (n = 5) and Liposarcoma(n = 5) were the most common primary tumor type. The mean operative time of Group A (298 min) was significantly longer than that of Group B (219 min)(P<0.05). ( Table 1 ) . Table 1 Summary of the patients’ profile AVR: artificial vascular replacement. *: P<0.05. Patients’ characteristics Group A N = 5 No. (%) Group B N = 7 No. (%) P value Female 1 (20.0) 2 (28.6) 0.636 Male 4 (80.0) 5 (71.4) Age (year) 53.2 ± 20.4 43.7 ± 13.9 0.357 Site of tumor Left 3 (60.0) 3 (42.9) 0.500 Right 2 (40.0) 4 (57.1) Tumor Primary 1 (20.0) 1 (14.3) 0.682 Recurred 4 (80.0) 6 (85.7) Histology Synovial sarcoma 2 (40.0) 3 (42.9) Liposarcoma 2 (40.0) 3 (42.9) Undifferentiated sarcoma 1 (20.0) 0 Fibrohistiocytoma 0 1 (14.2) Vascular reconstruction Autologous vein 0(0.0) 2 (28.6) 0.318 AVR 5(100.0) 5 (71.4) Operative time (mins) 297.6 ± 85.1 219.0 ± 19.6 0.037* Complications In group A, femoral vein blockage was the most common early complication, occurring in 3 patients (60%). Re-operation was conducted in 3 patients: 2 (33.3%) in group A and 1 (14.3%) in group B due to perioperative complications. The most common late complication, limb edema, was noted in 4 patients, including 1(20%) from Group A and 3(42.9%) from Group B. It seems that limb edema is more likely to occur in Group B than in Group A. One patient (14.3%) in group B required open drainage and debridement due to wound infection. Femoral artery blockage was noted in one patient (14.3%) from group B seven months after the first procedure. The patient underwent debridement and the artificial artery prosthesis was removed. There was one case of amputation due to infection in another hospital in Group A. ( Table 2 ) . Table 2 Postoperative complications during the follow-up period. Variable Group A N = 5 No. (%) Group B N = 7 No. (%) P value 30-d postoperative complications Hematoma 0 1 (14.3) 0.583 Wound delayed healing 0 1 (14.3) 0.583 Venous graft occlusion 3 (60.0) 0 0.045* Re-operation 1(20.0) 1 (14.3) 0.682 Number of people with perioperative complications 3 (60.0) 2(28.6) 0.311 Late postoperative complications Limb edema 1 (20.0) 3 (42.9) 0.424 Wound infection 0 1 (14.3) 0.583 Arterial graft occlusion 0 1 (14.3) 0.583 Amputation 1 (20.0) 0 0.417 Recurrence 0 0 Distant metastasis 0 1 (14.3) 0.583 Death 0 0 Number of people with long-term complications 2(40.0) 4(57.1) 0.500 *: P<0.05. Oncologic outcome Oncologic outcome The median follow-up periods of Group A and group B were 50 months (range, 30–77 months) and 43 months (range, 24–62 months), respectively. The limb salvage rate in Group A was 80% versus 100% in Group B. One patient developed pulmonary metastasis in group B seven months after surgery. All of patients remained alive at the last follow-up. Overall disease-free survival was 100% (5 of 5) in Group A compared with 85.7% (6 of 7) in Group B. At the final evaluation, the average Musculoskeletal Tumor Society score of Group A and Group B was 23.0 ± 4.7 points and 25.4 ± 2.5 points, respectively. Figure 1 and Fig. 2 are typical cases. Discussion STSs are malignant tumors that are relatively rare and have a significant risk of local recurrence, affecting around 11–65% of patients[ 7 , 10 – 12 ]. Radical resection with an appropriate tumor-free margin still stands as the fundamental approach in therapeutic management[ 13 , 14 ]. With the development of adjuvant therapy, vascular reconstruction technology, and imaging techniques, limb salvage surgery is gradually as the primary treatment option[ 8 , 15 , 16 ]. It is crucial to reconstruct the artery in limb salvage surgery when the tumor involves the major vessel. Adequate perfusion guarantees the limb viability and preserves limb function[ 17 – 19 ]. However, whether femoral vein reconstruction is needed remains controversial. Some surgeons favor vein reconstruction to prevent postoperative lymphedema and a subsequent decrease in arterial perfusion[ 7 , 20 , 21 ]. While some scholars argue that lymphedema is associated with extensive resection and vein reconstruction is not required[ 22 , 23 ]. Additionally, there was a high incidence of vein occlusion leading to same degree of leg swelling[ 24 , 25 ]. This study sought to compare surgical outcomes of limb-salvage surgery with or without femoral vein reconstruction for soft tissue sarcomas of the thigh. Our results showed that operation time of group B was substantially less than that of group A (P<0.05). In group A, femoral vein blockage was the most common early complication. Limb edema is more likely to occur in Group B than in Group A. However, no significant differences were found between the two groups in terms of the limb salvage rate, MTS score, re-operation rate, and 2-year main patency. To some extent, femoral vein reconstruction does not improve postoperative functional recovery after STSs resection. On the contrary, it will prolong the operation time and increase the surgical complications. In our study, three (60%) patients in Group A experienced early venous thrombosis. One of them had no further issues after conservative management with anticoagulation and limb elevation. The other two patient underwent debridement drainage and venous prosthesis removal following the failure of conservative treatment. According to Daedo et al, the venous thrombosis rate was 38.5%[ 7 ]. Schwarzbach et al observed a higher rate of venous thrombosis (42%) for lower limb STSs[ 25 ]. Moreover, the total perioperative complication rate was 50.0% in our study, which was in line with Masahide's meta-analysis of 18 studies, who found an overall perioperative complication rate of 49.5%[ 1 ]. The edema rate (33.3%) and incision infection rate (7.7%) are in line with reports in earlier literature[ 1 , 3 , 10 , 26 ]. The overall limb salvage rate of 91.7% is consistent with that reported in recent studies (74%-94%)[ 3 , 7 , 26 ]. Eleven patients had excellent MSTS score at the time of the last follow-up and only one patient underwent amputation due to infection. Wide excision or radiation therapy are two options for treating local tumor recurrence. The most crucial factor in determining local tumor management is obtaining sufficient surgical margins. During surgery, every patient in this research had free margins, and postoperative follow-up showed that no recurrence occurred. One individual in this study had distant metastases within a year of surgery. The disease-free survival rate was 91.7%, in line with earlier findings from Mohamed et al, Cetinkaya et al and Nishinari et al[ 3 , 8 , 10 ]. The non-necessity of femoral vein reconstruction may be attributed to compensatory venous collateral circulation in the lower extremity. Due to the absence of initial symptoms in soft tissue sarcomas of the thigh, these malignancies are particularly prone to missed or delayed diagnosis[ 27 , 28 ]. As the tumor progressively enlarges and exerts mechanical compression on the femoral vein and great saphenous vein, this pathological process induces the development of venous collateral circulation. This adaptive mechanism effectively compensates for compromised venous drainage and adequately maintains venous return from the affected lower limb[ 29 ]. Consequently, even after tumor resection without subsequent venous reconstruction, the established collateral network demonstrates sufficient hemodynamic capacity to sustain physiological fluid return requirements. This pathophysiological phenomenon potentially explains the clinical feasibility of omitting venous reconstruction procedures in selected cases. This study had several shortages. To begin with, the sample size is small, which makes a more thorough statistical analysis difficult. Additionally, we had no objective measurements of the postoperative limb swellings compared to the contralateral leg. Finally, the follow-up duration of this study was relatively short. Studies with a longer observation period and larger sample sizes are needed. Conclusion Femoral arterial reconstruction alone effectively treats thigh STSs involving the femoral vasculature while femoral vein reconstruction does not significantly improve management in these cases. On the contrary, it will prolong the operation time and increase the surgical complications. Abbreviations AVR artificial vascular replacement STSs soft tissue sarcomas MSTS Musculoskeletal Tumor Society Declarations Ethics approval and consent to participate The Ethics Committee of the Sun Yat-sen University Cancer Center support this study. All patients gave their written informed consent. All procedures involving human participants were carried out in accordance with the ethical standards of the institutional and national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Clinical trial number Not applicable. Consent for publication Written informed consent to participate in this study was obtained from all participants, and parent/ guardian consent was obtained for participants under the age of 18. Availability of data and materials The datasets used during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare no competing interests. Funding This study was supported by the Characteristic Innovation Projects for General Higher Education Institutions in Guangdong Province in China (No.2024KTSCX294). Authors' contributions All authors contributed to the study conception and design. Wenquan Xu and Jinxin Hu collected the clinical data, image data, and pathology data of the patients. Xiaojun Zhu conducted the statistical analysis. Wenquan Xu and Jinxin Hu was a major contributor in writing the manuscript. Xiaojun Zhu and Tao Zhang were mainly responsible for the project administration and editing of the article. Acknowledgements Not applicable. References Fujiki M, Kimura T, Takushima A. 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Cite Share Download PDF Status: Published Journal Publication published 01 Dec, 2025 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Revision requested 30 Jul, 2025 Reviews received at journal 29 Jul, 2025 Reviewers agreed at journal 13 Jul, 2025 Reviewers agreed at journal 11 Jul, 2025 Reviews received at journal 10 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviewers invited by journal 07 Jul, 2025 Editor invited by journal 07 Jul, 2025 Editor assigned by journal 27 Jun, 2025 Submission checks completed at journal 27 Jun, 2025 First submitted to journal 27 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6932024","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":482652872,"identity":"d29b77e0-64ea-4e07-b0b3-3de6b5611efa","order_by":0,"name":"Wenquan Xu","email":"","orcid":"","institution":"Sun Yat-Sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Wenquan","middleName":"","lastName":"Xu","suffix":""},{"id":482652873,"identity":"dbd37946-c354-4ac0-8407-d30bff2665b2","order_by":1,"name":"Jinxin Hu","email":"","orcid":"","institution":"Sun Yat-Sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Jinxin","middleName":"","lastName":"Hu","suffix":""},{"id":482652874,"identity":"7864575f-3e4b-44cd-b7af-cdff454b3094","order_by":2,"name":"Xiaojun Zhu","email":"","orcid":"","institution":"Sun Yat-Sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Xiaojun","middleName":"","lastName":"Zhu","suffix":""},{"id":482652875,"identity":"69a75396-29a7-46a8-b7f1-f187dccbaeb1","order_by":3,"name":"Tao Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYDACCSjND6UZG4jTksDAINlAshaDA8RqkZ/d/Ozh1x92csbnlz+T/MFgI7vhAPOzB/i0MM45Zm4sk5BsbHbjQZo0D0Oa8YYDbOYG+LQwSySYSUskMCduu3Hg2G0GhsOJGw7wsEng08Imkf4NqKU+cfOMg203fzD8J6yFRyLHTPJDAtBw/ma2GzwMBwhrkZDIKZNmSDtuLHGDjf03j0Gy8czDbGZ4tcjPSN8m+cOmWo6///hjwx8VdrJ9x5uf4dUCAsw8YPsSgAQoqJgJqQcCxh8gkv8AEUpHwSgYBaNgRAIA3VZHqtK1NUUAAAAASUVORK5CYII=","orcid":"","institution":"Guangzhou Health Science College","correspondingAuthor":true,"prefix":"","firstName":"Tao","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-06-19 14:08:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6932024/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6932024/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-025-09331-2","type":"published","date":"2025-12-01T15:58:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86651566,"identity":"7f2aa7e3-fecd-4637-a393-417b257d5f70","added_by":"auto","created_at":"2025-07-14 09:53:16","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":136100,"visible":true,"origin":"","legend":"\u003cp\u003eCase 1: A. Preoperative axial MR images of a patient with synovial sarcoma. B. The resected tumor mass with involved vessels. C. Following tumor resection, femoral arterial reconstruction was performed using contralateral great saphenous veins.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6932024/v1/92731bf900b767b13160b26e.jpg"},{"id":86651564,"identity":"419d6ff2-cc85-4e20-a533-0ac7a0e677f2","added_by":"auto","created_at":"2025-07-14 09:53:16","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":119903,"visible":true,"origin":"","legend":"\u003cp\u003eCase2: A \u0026amp; B. Preoperative sagittal and axial MR images of another patient with synovial sarcoma. C. The resected tumor mass with involved femoral vessels D. Femoral arterial and venous reconstructions were performed with artificial grafts.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6932024/v1/fa37731b38b27e7497d7b390.jpg"},{"id":97723947,"identity":"64709674-8062-4569-a8c3-9c3b78a6e908","added_by":"auto","created_at":"2025-12-08 16:10:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":860556,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6932024/v1/7287b913-6484-454e-813f-b04d9e5ee901.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Surgical outcomes of limb-salvage surgery with or without femoral vein reconstruction for soft tissue sarcomas of the thigh","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSarcomas have a low incidence, accounting for less than 1% of all malignant tumors[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It can occur throughout the body, with 50% of cases occurring in the extremities[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Among these, 5\u0026ndash;10% involve major blood vessels[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Traditionally, the usual treatment option for sarcomas that affect the major blood arteries of the lower extremities is amputation to ensure a tumor-free margin. However, limb salvage has emerged as the primary therapeutic option for lower extremity malignant tumors as a result of the accessibility of contemporary surgical techniques[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Meanwhile, for social or psychological reasons, a large number of patients refuse amputation[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. For soft tissue sarcomas (STSs) of the thigh that compromise major blood vessels, The procedure consists of tumor and vital vascular resection, followed by segmental vascular reconstruction. At present, the main surgical techniques for vascular reconstruction after soft tissue sarcoma (STSs) resection include artificial blood vessel reconstruction and autologous vascular transplantation[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, whether femoral vein reconstruction is needed remains controversial. In this study, we retrospectively reviewed the outcomes of patients with STSs who underwent limb salvage surgery at our hospital to evaluate the necessity of femoral vein reconstruction.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003eThe inclusion criteria for patients were as follows: (I) Patients with primary or recurrent soft tissue sarcoma of the thigh; (II) A diagnosis of thigh STSs was confirmed through pathological examination; (III) Imaging shows that the tumor encases or invades the femoral blood vessels; (IV) Patients with a strong desire for limb salvage. Every patient or their legal guardian provided informed consent. Between May 2017 and October 2021, twelve patients with thigh STSs were treated with en bloc excision and vascular reconstruction. The histological diagnosis was confirmed preoperatively via needle biopsy under ultrasound guidance for newly diagnosed patients. Imaging examinations, such as MRI scan of the lesion, CT scan of the chest and whole body bone scan, were performed after a clinical diagnosis to evaluate the tumor mass, soft-tissue involvement, infiltration of surrounding tissues, and margins of resection. All of the tumors were staged according to Enneking system. Restaging was undertaken after two to three pre-operative cycles at three weeks intervals if necessary. All procedures were performed by a single senior surgeon. Prior to surgery, all patients underwent Doppler ultrasonography of the lower limbs to assess the vascular status of both sides.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eTreatment and rehabilitation\u003c/h2\u003e\u003cp\u003eThe thigh STSs and the affected femoral artery and vein were separated from the surrounding normal tissues. The vessels were occluded with vascular clamps. The tumor component, the affected vasculature and the nearby muscles were resected in an en bloc fashion. The length and diameter of the damaged vessels were measured to choose appropriate artificial blood vessel or autologous great saphenous veins.\u003c/p\u003e\u003cp\u003eAll patients received anti-inflammatory, anticoagulant, and volume expansion therapies postoperatively. All patients received subcutaneous injections of low molecular weight heparin (6000 units) after the drainage tube was removed. After discharge, the patients were usually prescribed oral rivaroxaban tablets (15 mg, bid) for three months and aspirin (100 mg, qd) for an additional three months.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEvaluation\u003c/h3\u003e\n\u003cp\u003eAge, gender, tumor location, histological type, transplant type, and other patient details were documented. Early and late surgical complications, vascular occlusion rate, and the reoperations rate were the primary outcomes. The functional outcomes were assessed via the MSTS Scoring System.\u003c/p\u003e\n\u003ch3\u003eFollow-up\u003c/h3\u003e\n\u003cp\u003eThe patients were clinically and radiologically (MRI) examined every three months for signs of infection and local recurrence for the next two years following surgery, and then every six months after that. To detect pulmonary metastases, a chest CT scan was performed every three months in the first two years and then every six months thereafter. Doppler ultrasound in lower limb is used to assess vascular patency every three months. The patients' radiological and clinical records were examined retrospectively. Functional assessments were made according to the Musculoskeletal Tumor Society (MSTS) Scoring System[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] 6 months after surgery. The time to patency was calculated in months from the date of operation to vessel occlusion.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll the statistical analyses were performed via Microsoft Excel (Microsoft, Washington, USA) and SPSS software (IBM, New York, USA). Categorical variables are expressed as counts (percentages), whereas continuous variable data are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Fisher\u0026rsquo;s exact test was used to investigate associations between categorical variables. Primary patency and disease-free survival were estimated via the Kaplan-Meier technique. For all the statistical tests, a 5% significance level was employed.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eDemographics\u003c/h2\u003e\u003cp\u003eTwelve consecutive patients with STSs of the thigh underwent en bloc excision and vascular reconstruction at our department. Five patients received femoral artery and vein reconstruction (group A), and seven patients were treated with femoral artery reconstruction alone (group B). One patient from group A and two patients from group B underwent vascular reconstruction with autologous veins, whereas the other patients underwent artificial vascular replacement. Synovial sarcoma (n\u0026thinsp;=\u0026thinsp;5) and Liposarcoma(n\u0026thinsp;=\u0026thinsp;5) were the most common primary tumor type. The mean operative time of Group A (298 min) was significantly longer than that of Group B (219 min)(P\u0026lt;0.05). \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of the patients\u0026rsquo; profile AVR: artificial vascular replacement. *: P\u0026lt;0.05.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatients\u0026rsquo; characteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup A\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;5 No. (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup B\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;7 No. (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.636\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (71.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53.2\u0026thinsp;\u0026plusmn;\u0026thinsp;20.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.7\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.357\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSite of tumor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.500\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (57.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.682\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecurred\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (85.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSynovial sarcoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiposarcoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (42.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUndifferentiated sarcoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFibrohistiocytoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (14.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVascular reconstruction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAutologous vein\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.318\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAVR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5(100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (71.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative time (mins)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e297.6\u0026thinsp;\u0026plusmn;\u0026thinsp;85.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e219.0\u0026thinsp;\u0026plusmn;\u0026thinsp;19.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.037*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eComplications\u003c/h3\u003e\n\u003cp\u003eIn group A, femoral vein blockage was the most common early complication, occurring in 3 patients (60%). Re-operation was conducted in 3 patients: 2 (33.3%) in group A and 1 (14.3%) in group B due to perioperative complications. The most common late complication, limb edema, was noted in 4 patients, including 1(20%) from Group A and 3(42.9%) from Group B. It seems that limb edema is more likely to occur in Group B than in Group A. One patient (14.3%) in group B required open drainage and debridement due to wound infection. Femoral artery blockage was noted in one patient (14.3%) from group B seven months after the first procedure. The patient underwent debridement and the artificial artery prosthesis was removed. There was one case of amputation due to infection in another hospital in Group A. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePostoperative complications during the follow-up period.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup A\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;5 No. (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup B\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;7 No. (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003cp\u003evalue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e30-d postoperative complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.583\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound delayed healing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.583\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVenous graft occlusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.045*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRe-operation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.682\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of people with perioperative complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.311\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLate postoperative complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLimb edema\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.424\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.583\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArterial graft occlusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.583\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmputation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.417\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistant metastasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.583\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of people with long-term complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.500\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*: P\u0026lt;0.05.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eOncologic outcome\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eOncologic outcome\u003c/div\u003e\u003cp\u003eThe median follow-up periods of Group A and group B were 50 months (range, 30\u0026ndash;77 months) and 43 months (range, 24\u0026ndash;62 months), respectively. The limb salvage rate in Group A was 80% versus 100% in Group B. One patient developed pulmonary metastasis in group B seven months after surgery. All of patients remained alive at the last follow-up. Overall disease-free survival was 100% (5 of 5) in Group A compared with 85.7% (6 of 7) in Group B. At the final evaluation, the average Musculoskeletal Tumor Society score of Group A and Group B was 23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 points and 25.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 points, respectively. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e are typical cases.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSTSs are malignant tumors that are relatively rare and have a significant risk of local recurrence, affecting around 11\u0026ndash;65% of patients[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Radical resection with an appropriate tumor-free margin still stands as the fundamental approach in therapeutic management[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. With the development of adjuvant therapy, vascular reconstruction technology, and imaging techniques, limb salvage surgery is gradually as the primary treatment option[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt is crucial to reconstruct the artery in limb salvage surgery when the tumor involves the major vessel. Adequate perfusion guarantees the limb viability and preserves limb function[\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, whether femoral vein reconstruction is needed remains controversial. Some surgeons favor vein reconstruction to prevent postoperative lymphedema and a subsequent decrease in arterial perfusion[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. While some scholars argue that lymphedema is associated with extensive resection and vein reconstruction is not required[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Additionally, there was a high incidence of vein occlusion leading to same degree of leg swelling[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study sought to compare surgical outcomes of limb-salvage surgery with or without femoral vein reconstruction for soft tissue sarcomas of the thigh. Our results showed that operation time of group B was substantially less than that of group A (P\u0026lt;0.05). In group A, femoral vein blockage was the most common early complication. Limb edema is more likely to occur in Group B than in Group A. However, no significant differences were found between the two groups in terms of the limb salvage rate, MTS score, re-operation rate, and 2-year main patency. To some extent, femoral vein reconstruction does not improve postoperative functional recovery after STSs resection. On the contrary, it will prolong the operation time and increase the surgical complications.\u003c/p\u003e\u003cp\u003eIn our study, three (60%) patients in Group A experienced early venous thrombosis. One of them had no further issues after conservative management with anticoagulation and limb elevation. The other two patient underwent debridement drainage and venous prosthesis removal following the failure of conservative treatment. According to Daedo et al, the venous thrombosis rate was 38.5%[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Schwarzbach et al observed a higher rate of venous thrombosis (42%) for lower limb STSs[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Moreover, the total perioperative complication rate was 50.0% in our study, which was in line with Masahide's meta-analysis of 18 studies, who found an overall perioperative complication rate of 49.5%[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe edema rate (33.3%) and incision infection rate (7.7%) are in line with reports in earlier literature[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The overall limb salvage rate of 91.7% is consistent with that reported in recent studies (74%-94%)[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Eleven patients had excellent MSTS score at the time of the last follow-up and only one patient underwent amputation due to infection.\u003c/p\u003e\u003cp\u003eWide excision or radiation therapy are two options for treating local tumor recurrence. The most crucial factor in determining local tumor management is obtaining sufficient surgical margins. During surgery, every patient in this research had free margins, and postoperative follow-up showed that no recurrence occurred. One individual in this study had distant metastases within a year of surgery. The disease-free survival rate was 91.7%, in line with earlier findings from Mohamed et al, Cetinkaya et al and Nishinari et al[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe non-necessity of femoral vein reconstruction may be attributed to compensatory venous collateral circulation in the lower extremity. Due to the absence of initial symptoms in soft tissue sarcomas of the thigh, these malignancies are particularly prone to missed or delayed diagnosis[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. As the tumor progressively enlarges and exerts mechanical compression on the femoral vein and great saphenous vein, this pathological process induces the development of venous collateral circulation. This adaptive mechanism effectively compensates for compromised venous drainage and adequately maintains venous return from the affected lower limb[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Consequently, even after tumor resection without subsequent venous reconstruction, the established collateral network demonstrates sufficient hemodynamic capacity to sustain physiological fluid return requirements. This pathophysiological phenomenon potentially explains the clinical feasibility of omitting venous reconstruction procedures in selected cases.\u003c/p\u003e\u003cp\u003eThis study had several shortages. To begin with, the sample size is small, which makes a more thorough statistical analysis difficult. Additionally, we had no objective measurements of the postoperative limb swellings compared to the contralateral leg. Finally, the follow-up duration of this study was relatively short. Studies with a longer observation period and larger sample sizes are needed.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFemoral arterial reconstruction alone effectively treats thigh STSs involving the femoral vasculature while femoral vein reconstruction does not significantly improve management in these cases. On the contrary, it will prolong the operation time and increase the surgical complications.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAVR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eartificial vascular replacement\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSTSs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esoft tissue sarcomas\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMSTS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMusculoskeletal Tumor Society\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of the Sun Yat-sen University Cancer Center support this study.\u003c/p\u003e\n\u003cp\u003eAll patients gave their written informed consent. All procedures involving human participants were carried out in accordance with the ethical standards of the institutional and national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent to participate in this study was obtained from all participants, and parent/ guardian consent was obtained for participants under the age of 18.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Characteristic Innovation Projects for General Higher Education Institutions in Guangdong Province in China (No.2024KTSCX294).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Wenquan Xu and Jinxin Hu collected the clinical data, image data, and pathology data of the patients. Xiaojun Zhu conducted the statistical analysis. Wenquan Xu and Jinxin Hu was a major contributor in writing the manuscript. Xiaojun Zhu and Tao Zhang were mainly responsible for the project administration and editing of the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFujiki M, Kimura T, Takushima A. Limb-salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta-analysis. Microsurgery. 2020;40(3):404\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSorrells RB. Extremity splinting-Part II: The lower extremity. J Ark Med Soc. 1981;77(9):361\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMlees MA, Elbarbary AH, Sallam EM. Vascular reconstruction using autologous vs synthetic graft for patients with extremity soft-tissue sarcoma involving the major vessels. J Surg Oncol. 2020;121(2):272\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCampanacci DA, Scoccianti G, Beltrami G, Mugnaini M, Capanna R. Ankle arthrodesis with bone graft after distal tibia resection for bone tumors. Foot Ankle Int. 2008;29(10):1031\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoore DR, Halpern JL, Schwartz HS. Allograft ankle arthrodesis: a limb salvage technique for distal tibial tumors. Clin Orthop Relat Res. 2005;440:213\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLaitinen M, Hardes J, Ahrens H, Gebert C, Leidinger B, Langer M, Winkelmann W, Gosheger G. Treatment of primary malignant bone tumours of the distal tibia. Int Orthop. 2005;29(4):255\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark D, Cho S, Han A, Choi C, Ahn S, Min SI, Ha J, Min SK. Outcomes after Arterial or Venous Reconstructions in Limb Salvage Surgery for Extremity Soft Tissue Sarcoma. J Korean Med Sci. 2018;33(40):e265.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCetinkaya OA, Celik SU, Kalem M, Basarir K, Koksoy C, Yildiz HY. Clinical Characteristics and Surgical Outcomes of Limb-Sparing Surgery with Vascular Reconstruction for Soft Tissue Sarcomas. Ann Vasc Surg. 2019;56:73\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEnneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993(286):241\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNishinari K, Krutman M, Aguiar Junior S, Pignataro BS, Yazbek G, Zottele Bomfim GA, Teivelis MP, Wolosker N. Surgical outcomes of vascular reconstruction in soft tissue sarcomas of the lower extremities. J Vasc Surg. 2015;62(1):143\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbbas JS, Holyoke ED, Moore R, Karakousis CP. The surgical treatment and outcome of soft-tissue sarcoma. Arch Surg. 1981;116(6):765\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilliard WC, Hajdu SI, Casper ES, Brennan MF. Comparison of amputation with limb-sparing operations for adult soft tissue sarcoma of the extremity. Ann Surg. 1992;215(3):269\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurns C, Gorina Faz M. An Analysis of Tumor Margin Shrinkage in the Surgical Resection of Squamous Cell Carcinoma of the Oral Cavity. Cureus. 2021;13(5):e15329.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim SG. Interpretation of Pathologic Margin after Endoscopic Resection of Gastrointestinal Stromal Tumor. Clin Endosc. 2016;49(3):229\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMisra A, Mistry N, Grimer R, Peart F. The management of soft tissue sarcoma. J Plast Reconstr Aesthet Surg. 2009;62(2):161\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGonzalez MR, Mendez-Guerra C, Goh MH, Pretell-Mazzini J. Principles of Surgical Treatment of Soft Tissue Sarcomas. Cancers (Basel) 2025, 17(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePedras S, Vilhena E, Carvalho R, Pereira MG. Psychosocial adjustment to a lower limb amputation ten months after surgery. Rehabil Psychol. 2018;63(3):418\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePenn-Barwell JG. Outcomes in lower limb amputation following trauma: a systematic review and meta-analysis. Injury. 2011;42(12):1474\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerner JE, Dearden A, Magdum AA, Crowley TP, Rankin K, Clarke MJ, Ragbir M. Safety of limb-salvaging surgery for sarcomas compromising major vessels: A 15-year single-centre outcomes study. J Plast Reconstr Aesthet Surg. 2021;74(9):2076\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEmori M, Hamada K, Omori S, Joyama S, Tomita Y, Hashimoto N, Takami H, Naka N, Yoshikawa H, Araki N. Surgery with vascular reconstruction for soft-tissue sarcomas in the inguinal region: oncologic and functional outcomes. 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Reconstruction of Complex Groin Defects After Sarcoma Resection. Ann Plast Surg. 2017;78(4):443\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaidari M, Malakzai HA, Haidary AM, Saadaat R, Hakimi A, Abdul-Ghafar J. Gossypiboma of thigh mimicking soft tissue sarcoma: A case report and review of the literature. Int J Surg Case Rep. 2023;106:108106.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorinaga S, Takeuchi A, Yamamoto N, Hayashi K, Miwa S, Igarashi K, Yonezawa H, Asano Y, Saito S, Nojima T, et al. Compartment-specific Clinical Outcomes in Patients With Soft Tissue Sarcomas of the Thigh. Anticancer Res. 2022;42(6):3143\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDodd SX, Morzycki A, Nickel KJ, Campbell S, Guilfoyle R. One or two venous pedicles by anastomoses for free flaps in reconstruction of the lower extremity: A systematic review and meta-analysis. Microsurgery. 2021;41(8):792\u0026ndash;801.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lower extremities, Soft tissue sarcoma, Femoral vessel replacement, Limb-salvage surgery, Complications","lastPublishedDoi":"10.21203/rs.3.rs-6932024/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6932024/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePurposes\u003c/strong\u003eThis study aims to evaluate the outcomes of limb salvage procedures utilizing femoral vessel replacement in patients who diagnosed with thigh soft tissue sarcomas involving the femoral vasculature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: 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 is reconstructed. 5 received femoral artery and vein reconstruction (group A) and 7 were treated with femoral artery reconstruction alone (group B). We used the Enneking and Musculoskeletal Tumor Society (MSTS) systems to stage our patients. We assessed complications, MSTS function, local recurrence and survival.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: 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 of group A and group B were 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 is 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 1 case in group B developed metastasis. The mean Musculoskeletal Tumor Society score of group A and group B at the final follow-up were 23 points and 25 points, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Femoral arterial reconstruction alone effectively treats thigh STSs involving the femoral vasculature while femoral vein reconstruction does not significantly improve management in these cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Evidence: IV\u003c/strong\u003e\u003c/p\u003e","manuscriptTitle":"Surgical outcomes of limb-salvage surgery with or without femoral vein reconstruction for soft tissue sarcomas of the thigh","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 09:53:07","doi":"10.21203/rs.3.rs-6932024/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-30T06:58:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-29T06:12:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52861580714425027101755817158078179421","date":"2025-07-13T04:25:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"127897976023512933875621432572372439292","date":"2025-07-12T02:32:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-10T07:02:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"240039883389759959038647073211357381479","date":"2025-07-09T01:29:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14254298950827434732946619430472281742","date":"2025-07-08T04:16:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-08T03:20:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-07T06:14:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-27T14:41:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-27T12:30:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-06-27T12:27:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2ab763b5-0f8a-4c23-904e-38a0f8f68ec8","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T16:03:22+00:00","versionOfRecord":{"articleIdentity":"rs-6932024","link":"https://doi.org/10.1186/s12891-025-09331-2","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2025-12-01 15:58:13","publishedOnDateReadable":"December 1st, 2025"},"versionCreatedAt":"2025-07-14 09:53:07","video":"","vorDoi":"10.1186/s12891-025-09331-2","vorDoiUrl":"https://doi.org/10.1186/s12891-025-09331-2","workflowStages":[]},"version":"v1","identity":"rs-6932024","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6932024","identity":"rs-6932024","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}