AIIMS docs perform limb salvage surgery for sarcoma patients

In a bid to avoid amputation of limbs of patients suffering from sarcoma, a deadly form of cancer, doctors at AIIMS have started performing limb salvage surgery using vascular reconstruction.
For sarcoma, malignant tumours of connective tissues, surgery is the only curative treatment. Tumours more than 10 cms in size usually tend to involve major vessels supplying blood to the limbs, compelling the surgeon to surgically remove the affected limb, said AIIMS Director M C Mishra. Sarcoma mostly affects the limbs and neck region.
"Removal of any body parts, particularly limbs, makes one crippled. It has got a huge bearing on the quality of life, particularly in India where rehabilitative processes are not that well developed. Also, there is lack of technology related to artificial prosthetic limbs and high cost involved.

"And that is why the best way to help these patients is to avoid amputations. By limb salvage surgery, it is possible to treat malignant tumours safely without resorting to amputation," said Mishra.
According to Dr Sunil Kumar, Assistant Professor of Surgical Oncology, as part of the treatment the affected blood vessels are reconstructed and replaced with veins and prosthetic vascular grafts taken from the patient's own body.
"The procedure helps preserve the patient's appearance and maintain his self-esteem. We also implant synthetic metal rods where bones are involved by the tumour. Using these grafts the blood flow to the limb is preserved so that the functional limb can be maintained and the person returns to his normal life with minimal rehabilitative assistance," said Kumar.

The latest case Kumar and his team handled is that of a 21-year-old man from Bihar who had a 12 cm sarcoma on his thigh involving the main vessels supplying blood to the lower limb.

"In normal circumstances, the man would have lost his limb. But we reconstructed his both the blood vessels (artery and veins) using artificial as well as a vein graft from his neck," Kumar said.
The surgical procedure lasts five to six hours. First the tumour is removed and then reconstruction begins.
"These procedures require a high level of expertise in vascular reconstructive surgery. These surgeries are generally associated with complications like failure of graft. In such a scenario, the supply of blood to the limb may get cut off leading to gangrene.

"So, not only the ability to perform these operations is necessary, but equally important is to detect and manage post-operative complications successfully. This procedure has pushed the boundaries of cancer surgery to overcome the limitations of limb preservation," said Kumar.