# Vascular Reconstruction in Extremity Soft Tissue Sarcomas: A Systematic Review and Single‐Arm Meta‐Analysis

## TL;DR

This study reviews outcomes of limb-sparing surgery with vascular reconstruction for soft tissue sarcomas in limbs, finding high limb salvage rates but significant complications.

## Contribution

A systematic review and meta-analysis of vascular reconstruction outcomes in extremity soft tissue sarcomas.

## Key findings

- Limb salvage rate was 89% with a 10% amputation rate.
- One- and five-year survival rates were 89% and 62%, respectively.
- Major complications included graft thrombosis, wound complications, and infections.

## Abstract

The management of extremity soft tissue sarcomas (STS) involving major vessels presents unique challenges, historically leading to amputation. Advances in vascular reconstruction have enabled limb‐sparing surgery (LSS), but outcomes and perioperative risks remain uncertain. This systematic review and meta‐analysis aimed to evaluate oncologic results following LSS with vascular reconstruction in extremity STS.

A systematic review and single‐arm meta‐analysis were performed according to PRISMA guidelines, with registration in PROSPERO. PubMed, Embase, and Cochrane Library were searched from inception to June 2025 for studies reporting outcomes in patients with extremity STS undergoing LSS with vascular reconstruction. Pooled analyses estimated limb salvage, survival, and complication rates using random‐effects models.

Thirty‐one studies comprising 520 patients were included. Approximately 58% were male, with a mean age ranging from 29.3 to 59 years. The most common tumor localizations were the thigh (59.5%), inguinal region (15.9%), and popliteal fossa (8.6%). Liposarcoma (24.0%), synovial sarcoma (19.6%), and osteosarcoma (14.8%) were the most frequent histological subtypes. The pooled limb salvage rate was 89% (95% CI, 86%–92%), while amputation occurred in 10% (95% CI, 8%–14%). One‐ and 5‐year overall survival rates were 89% and 62%, respectively, with disease‐free survival rates of 74% and 55%. Major complications included graft thrombosis (19%), wound complications (29%), and wound infection (22%).

Limb‐sparing surgery with vascular reconstruction is effective for extremity STS involving major vessels, enabling high limb salvage and favorable long‐term survival without compromising oncologic outcomes. However, substantial perioperative morbidity persists, underscoring the need for multidisciplinary care, careful patient selection, and prospective studies to refine indications and enhance quality of life.