(P 269) LYMPHOEDEMA FOLLOWING LIMB SALVAGE SURGERY FOR EXTREMITY SARCOMA: A RETROSPECTIVE ANALYSIS OF 282 PATIENTS

Objective: Sarcomas are rare, aggressive cancers, most commonly arising in the extremities. The cornerstone of curative management remains surgical resection with a wide margin. Where possible, this is in the form of limb salvage surgery due to the improved functional outcomes compared to amputation. Given the extent of surgery required, this often results in damage to lymphatic and blood vessels, resulting in secondary lymphoedema. Unfortunately, despite the significant impact of lymphoedema on patient’s quality of life, and the healthcare cost of its secondary effects, there has been little work to investigate the prevalence of lymphoedema and the risk factors associated with its development in sarcoma patients. Studies in breast cancer demonstrate that prompt detection and basic treatment in the form of compression garments and manual drainage reduce the development of clinical lymphoedema, whilst surgical treatments such as lymphovascular anastomosis and vascularised lymph node transfers continue to progress, demonstrating that both prevention and treatment of this issue is possible. The aims of this study were as follow:
1) To identify the incidence and severity of lymphoedema in patients undergoing limb salvage surgery for extremity sarcoma
2) To identify risk factors for the development of lymphoedema in patients undergoing limb salvage surgery for extremity sarcoma

Methods: All patients treated with limb salvage surgery for extremity sarcoma at the North of England Bone and Soft Tissue Tumour Service between July 2012 and July 2017 were identified from a prospective database. All patients included had a histologically confirmed diagnosis of sarcoma. Patients undergoing amputation or with sarcomas arising in axial or visceral locations were excluded. Lymphoedema severity was evaluated according to the International Society of Lymphology classification system and information on risk factors collected from clinical records. Binary logistic regression was used to evaluate the role of risk factors on the development of lymphoedema.

Results: 282 patients were identified as suitable for inclusion in the study. A total of 49 patients (17.4%) developed lymphoedema during follow up. This was mild in 46.9%, moderate in 42.9% and severe in 10.2% of patients developing lymphoedema. There was a median time to development of 6 months. Of the 49 patients developing lymphoedema, there was a higher proportion of lower limb primaries (p< 0.001), primaries < 5cm in diameter (p=0.05), complex reconstruction (not amenable to primary closure, p=0.04), early complications (p< 0.001) and patients receiving radiotherapy (p< 0.001). Analysis with binary logistic regression demonstrated that sarcomas arising in the lower extremity (OR 5.661, p< 0.001), early post-operative complications such as seroma or wound infection (OR 4.612, p< 0.001) and radiotherapy (OR 8.876, p< 0.001) were all associated with increased risk of lymphoedema development during follow up, with all 3 risk factors remaining significant at the multivariate level.

Conclusion: Lymphoedema is a significant long-term complication that effects a high proportion (17.4%) of patients with extremity sarcoma. Further work is needed to both improve the early identification of these patients and to develop improved surgical and non-surgical preventative techniques to prevent this troubling complication.