Occurrence and prognosis of lymph node metastases in patients selected for isolated limb perfusion with soft tissue sarcoma

François Crettenand¹, David Martin², Stéphane Cherix^3,4, Nicolas Demartines^2,4,✉, Maurice Matter^2,4,✉

1. Department of Urology, University Hospital CHUV, Lausanne, Switzerland
2. Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
3. Department of Orthopaedics and Traumatology, University Hospital CHUV, Lausanne, Switzerland
4. Sarcoma Center, University Hospital CHUV, Lausanne, Switzerland

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Citation:
Crettenand F, Martin D, Cherix S, Demartines N, Matter M. Occurrence and prognosis of lymph node metastases in patients selected for isolated limb perfusion with soft tissue sarcoma. J Cancer 2018; 9(18):3311-3315. doi:10.7150/jca.25696. Available from https://www.jcancer.org/v09p3311.htm

Abstract

Background and Objectives: Extensive surgery is often required for advanced soft tissue sarcoma (STS) of the limb. In the 1980s, a new approach was developed: isolated limb perfusion (ILP). This study aimed to assess incidence and impact on patient survival based on lymph node metastasis with systematic radical lymphadenectomy during ILP.

Methods: Retrospective study of 57 consecutive patients treated by ILP for limb STS with simultaneous radical lymph node dissection in our tertiary referral center between 1992 and 2015.

Results: Median age was 62 years (19-87) and 30 patients were male (53%). Lymph node involvement was observed in 13 patients (N1, 23%), regarded as metastatic spreading in 4 angiosarcomas, 3 epithelioid sarcomas, 2 leiomyosarcomas, 2 undifferentiated sarcomas and 2 synovial sarcomas. For the N0 patient group, median survival was 73.9 months (CI 95% 41.9-105.9) compared to 15.1 months (CI 95% 7.4-22.6) in case of metastatic lymph node (p=0.002). The median disease-free survival was 33,0 months (CI 95% 12,5-53.5) in N0 group and 8.0 months (CI 95% 4.0-11.9) in N1 (p=0.006).

Conclusions: Lymph node metastases of STS patients selected for ILP seemed to have a negative impact on both overall and disease-free survival. Radical lymph node dissection should be included in ILP procedure.

Keywords: limb sarcoma, lymph node metastases, incidence, prognosis