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Malignant bone cancer with neuro vascular involvement healed, devoid of limb amputation

Large Soft tissue carcinoma is a very uncommon disease in which the preservation of the limb has become increasingly possible in lesions affecting the extremities due to improved surgical skill and multimodality therapy. Limb salvage surgery was found to result in equal survival but higher rates of local recurrence than amputation.

High grade sarcomas are characterized by an increased rate of infiltration to neurovascular bundles and a high rate of distant metastases.The attachment of tumors to major vascular structures with adequate margins of clearance difficult to achieve has to be regarded as a major limitation of effective surgical therapy. Previously, amputation had been the adequate treatment, but the problem of systemic spread could not be solved by this procedure either. Vessel-invasive tumors often present as recurrent disease, resulting in positive margins after tumor resection. Both adverse prognostic factors further contribute to the poor outcome.

To save the limb despite the vessel-invasive tumors, limited resections combined with brachytherapy to the tumor bed have been applied successfully.However, as a sole surgical treatment, radical resection, including removal of the vessels infiltrated by tumor, with consecutive reconstruction using an allograft or an autologous vein bypass was inaugurated more than 15 years ago.

Latterly limb salvage surgery has become the standard of care in managing extremity sarcomas.With recent advances in radiotherapy and chemotherapy, 95% of patients with extremity sarcomas can have limb conservation surgery but five per cent of these patients will still require amputation. Common indications for amputation are major neurovascular involvement and large primary tumor where resection would leave a functionally useless limb.

Lately at BhagwanMahaveer Cancer Hospital & Research Centre (BMCHRC) offered limb salvage to Manjit Singh, a resident of Ganganager in Rajasthan who was diagnosed of Large Soft Tissue Sarcoma (9Kg) with Neuro Vascular involvement.

Manjit after visiting several hospitals for treatment and bearing months of pain in his joints and muscles facing difficulty in walkingunderwent several investigations which revealed that he is afflicted bybone cancer and was suggested leg amputation.

First he was operated sometime in 2013 but the surgery was not successful and swelling progressed. Post getting defeated multiple times Manjit visited me at BMCHRC. Me and my team conducted Limb Salvage Surger on him and removed a tumor that weighed 9kg along with reconstructing the vessels securing them from the opposite leg.

Post exhaustive yet successful surgery and few physiotherapy sessions Manjit recovered and regained the strength of his legs and walked out from BMCHRC with a grin of happiness and satisfaction.

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rajni@medgatetoday.com

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