Lymphatic complications after thigh soft tissue sarcoma resection in the era before lymphatic reconstructive surgery - a retrospective cohort analysis.

Introduction: Patients undergoing curative treatment for soft-tissue sarcomas (STS) of the thigh bear the risk of developing lymphatic fistula and lymphedema. Innovative microsurgical concepts such as primary preventive lymphatic reconstruction show promising results. To discuss the likelihood of lymphatic complications after limb-preserving treatment of STS in the era before lymphatic reconstructive surgery and depending on the sarcoma location in the thigh became paramount in treating these patients.  Methods: We reviewed clinical data of 471 patients who underwent curative lower limb sarcoma treatment at our institution during the period from 2005 to 2019. We allocated patients into cohorts depending on the tumor location in the thigh respecting anatomical compartments as medial, posterior and the anterior compartment. We primarily analyzed incidences of postoperative lymphatic fistula and lymphedema.

Results: We included 69 patients into this study. Mean follow-up period was 36 months. The overall incidence of lymphatic complications was 69.6% (48 of 69 patients). Lymphatic fistulas in general (symptomatic and asymptomatic, ±lymphedema) were observed in 55% of all patients (38 of 69), whereas lymphedema occurred in 47.8% of all our patients (33 of 69). Lymphatic fistula alone occurred in 15 patients (21.7%) and lymphedema alone occurred in 10 patients (14.5%).

Conclusions: Incidences of lymphatic complications after limb-preserving curative treatment of STS of the thigh are high and vary depending on the exact tumor location. Medial and anterior thigh sarcomas are at high risks for lymphatic complications. Our results might facilitate selecting high-risk patients and aid in justifying preventive microsurgical strategies.